9/20 Tic Disorders - Petti

Question 1

tic

Answer 1

sudden, rapid, recurrent, non-rhythmic, stereotyped motor movement/vocalization causing distress or significant impairment

• often involuntary OR response to irresistible urge
• onset before 18 yr

2 types:

1. motor

• simple motor tics
• complex motor tics

2. vocal

• simple vocal tics
• complex vocal tics

Question 2

simple motor tics

Answer 2

sudden, brief, sterotypic, repetitive movements

• can be embarassing/painful
  ex. eye blink, grimace, jaw snap, lip pout, tensing or rapid jerking of body part (arm/head/neck)

Question 3

complex motor tics

Answer 3

often slower than simple tics

orchestrated series of what appears to be more purposeful, longer movement

ex.

• echopraxia: imitating movements or gestures of other people
  
  • hopping, clapping, touching things/others/self, gyrating/bending, thrusting arms, facial gestures, kissing, punching, tearing paper while writing
• copraxia: obscene, aggressive, otherwise inapprop gestures (middle finger)
• self injurious: violent head jerks, tongue biting, pinching, eye poking

Question 4

simple vocal tics

Answer 4

often at points of initiation/transition in speech

• meaningless sounds
  
  • throat clearing, coughing, sptting, screeching, barking, grunting, whistling, hissing
• syllable sounds (uhuh, eee, bu)

Question 5

complex vocal tics

Answer 5

• meaningful utterances of words/phrases
  
  • oh boy, you know, shut up, youre fat, whats that
• interruptions in flow of speech
• sudden alterations in pitch/vol
• echolalia: repeating others’ words
• palilalia: repeating one’s own words
• copralalia: often explosive utterances of obscene, aggressive, socially unacceptable words/phrases (racial slurs, etc)
  
  • most socially impairing complex symptom
  • not spoken in anger, meant to offend
  • usually first syllable of an inapprop word will interrupt an otherwise approp flow of words

Question 6

Tourette’s Disorder

criteria

Answer 6

1. multiple motor + one or more vocal tics present at some point during illness
   * can wax and wane; not necessarily concurrent
2. occur several times/day over 1+ yr since tic onset
3. onset before 18yo
4. NOT due to physiologic effects of a substance (ex. cocaine) or med condition (ex. Huntington’s, Wilson’s, post viral enceph)

Question 7

persistent (chronic) motor/vocal tic disorder

Answer 7

single or multiple motor or vocal tics present at some poing during illness, BUT NEVER BOTH

all other criteria identical to Tourette’s

• in this case, Tourette’s criteria are not met

Question 8

provisional tic disorder

Answer 8

single or multiple motor or vocal tics present at some time during illness

• BUT present for <1 yr since tic onset!

other criterio identical to those for Tourette’s, but Tourette’s disorder criteria are not met

Question 9

tic disorder stats

Answer 9

boys:girls = 2:1

relatives of those with TD are at 10-100x incr risk for tic disorders

• autosomal dominant
• monozygotic twins have concordance of 77-94% for chronic tic disorders
• dizygotic twins have concordance of 23%

Question 10

tic characteristics

Answer 10

antecedent sensory feeling (itch to scratch, etc)

• often irresistible

possible that sensory cues prompt particular tic (ex. grunt, throat clearing)

sometimes painful or source of mental impairment

coprolalia present in approx 10% of ticks

Question 11

Tourette’s disorder: course of disease

Answer 11

• tics usually decrease in intensity through adolescence and may be absent in adulthood
• anatomic location, freq, and severity of tics can/do change over time
  
  • severity worse b/w 9-12 yr
  • often see hyperactive behavior from 3+
  • simple motor of eyes/face/head → neck/shoulders → arms/hands → 6+: trunk/legs

Question 12

environmental influences

Answer 12

some stimuli can exacerbate:

• temp changes
• illness
• fatigue
• stress

PANDAS: pediatric autoimmune neuropsych disorder associated with strep infection

• GroupA beta-hemolytic strep preceded tics in 44% of children with sx
• minority of pt positive for antibodies
• assoc with wide range of other disorders

Question 13

factors affecting symptom severity

Answer 13

• psych stress
• infectious disease
  
  • PANDAS, Lyme, viruses, bacteria, Mycoplasma penumo
  • noninfectious immunological response
• deficits in procedural learning, fine motor control, visual motor integration, and motor inhibition
• inability of BG to suppress motor neural areas that initiate tics
• abnormal dopamine modulation

Question 14

TS without comorbid disorders?

Answer 14

IQ benefits!

• higher IQ
• fewer learning disabilities

athletic advantages!

• faster timed motor tasks → cont into adulthood