Secondary tics and tourettism

Abstract

Motor and phonic tics are most frequently due to Tourette syndrome, but there are many other causes of tics. We analyzed data on 155 patients with tics and co-existent disorders (101M/54F; mean age 40.5 +/- 20.2 years). Fourteen (9.0%) patients had tics associated with an insult to the basal ganglia, such as head trauma (N = 4, 2.5%), stroke (N = 2, 1.2%), encephalitis (N = 3, 1.9%) and other causes. In addition, certain drugs, toxins, and post-infectious causes were associated with tics. Rarely, peripheral injury can cause movement disorders, including tics (N = 1, 0.6%). Pervasive developmental disorders, including Asperger's syndrome (N = 13, 8.3%), mental retardation (N = 4, 2.5%), autism (N = 3, 1.9%), and Savant's syndrome (N = 1, 0.6%), also may be associated with tics, as noted in 21 of the 155 patients (13.5%). Genetic and chromosomal disorders, such as Down's syndrome 5 (3.2%), neuroacanthocytosis (N = 2, 1.2%), and Huntington's disease (N = 1, 0.6%), were associated with tics in 16 patients (10.3%). We have also examined the co-existence of tics and other movement disorders such as dystonia (N = 31, 20.0%) and essential tremor (N = 17, 10.9%). Sixteen (10.3%) patients presented psychogenic tics, and one (0.6%) psychogenic tics and dystonia; conversely, Tourette syndrome preceded the onset of psychogenic dystonia (N = 1, 0.6%), and psychogenic tremor (N = 1, 0.6%) in two patients. Finally, 12 (7.7%) patients had tics in association with non-movement related neurological disorders, such as static encephalopathy (N = 2, 1.2%) and seizures (N = 3, 1.9%). To understand the physiopathology of tics and Tourette syndrome, it is important to recognize that these may be caused or associated with other disorders.

Tic disorders: some key issues for DSM-V

“…[47] Recommendation: We recommend retaining the current exclusion criterion for the tic disorders, but also recommend creating new categories in parallel with other DSM diagnoses for those tic disorders where there is a known cause. Tic disorders due to a misuse of an illegal substance (such as cocaine [48] ) should be classified as Substance (indicate the substance) Induced Tic Disorder and those tic disorders with a known medical cause (such as stroke, encephalitis, or head trauma [48] ) should be diagnosed with ''Tic Disorder due to y'' (indicate the general medical condition).…”

Tourettism in Multiple Sclerosis: A case report

“…The term "Tourettism" was introduced by Sacks [2] to describe acquired TS-like symptoms associated to several aetiologies. Tics associated with ADHD and/or OCD have been reported as secondary to a variety of acquired and congenital neurological and neuropsychiatric disorders or following exposure to several drugs [3]. We described here a young woman affected by Multiple Sclerosis (MS) who progressively developed TS-like symptoms.…”

Treatment of Tics and Tourette Syndrome

“…All patients with tics should be evaluated to ensure the proper diagnosis and to eliminate the possibility that tics are secondary to another medical condition (Tic disorder-NOS) [7]. A personal interview of the patient and parent and the use of standardized parent/teacher questionnaires are helpful in identifying comorbid psychopathology and academic problems.…”