Impact of the COVID-19 pandemic on incidence of tics in children and young people: a population-based cohort study

Jack, Ruth H; Joseph, Rebecca M.; Coupland, Carol; Hall, Charlotte L; Hollis, Chris

doi:10.1016/j.eclinm.2023.101857

Cited by 8 publications

(5 citation statements)

References 32 publications

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“…A large population-based study recently conducted in England documented an increased incidence of tics in children and young people of all age groups and genders during the COVID-19 pandemic, with a differentially greater effect in teenage girls (more than four-fold increase) and an association with mental health disorders including anxiety. In addition to confirming early data from international reports, these findings suggested that this rise might have been driven by the emotional and social impact of the pandemic on teenage girls, and that functional tics should be considered as part of the differential diagnosis [6].…”

Section: Introductionsupporting

confidence: 67%

New‐onset functional tics during the COVID‐19 pandemic: Clinical characteristics of 105 cases from a single centre

Cavanna

Purpura

Riva

et al. 2023

Euro J of Neurology

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Background and purpose:The COVID-19 pandemic has been associated amongst other things with a sharp increase in adolescents and young adults presenting acutely with functional tics. Initial reports have suggested clinically relevant differences between functional tics and neurodevelopmental tics seen in primary tic disorders such as Tourette syndrome. We aimed to provide confirmatory findings from the largest single-centre cohort to date. Methods:In the present study we present data from 105 consecutive patients who developed functional tics during a 3-year period overlapping with the COVID-19 pandemic (April 2020-March 2023). All patients underwent a comprehensive neuropsychiatric assessment at a single specialist centre for tic disorders.Results: Female adolescents and young adults accounted for 69% of our sample.Functional tics had an acute/subacute onset in most cases (75% with a peak of severity within 1 month). We found a disproportionately high frequency of complex movements (81%) and vocalizations (75%). A subset of patients (23%) had a pre-existing primary tic disorder (Tourette syndrome with functional overlay). The most common psychiatric comorbidities were anxiety (70%) and affective disorders (40%). Moreover, 41% of patients had at least one functional neurological disorder in addition to functional tics. Exposure to tic-related social media content was reported by half of the patients. Conclusions:Our findings confirm substantial clinical differences between functional tics developed during the pandemic and neurodevelopmental tics. Both patient-and ticrelated red flags support the differential diagnostic process and inform ongoing monitoring in the post-pandemic era.

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Section: Introductionsupporting

confidence: 67%

New‐onset functional tics during the COVID‐19 pandemic: Clinical characteristics of 105 cases from a single centre

Cavanna

Purpura

Riva

et al. 2023

Euro J of Neurology

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“…In a population-based study, Jack and colleagues reported that the incidence of tics in children and young people increased across all age and sex groups during the COVID-19 pandemic, especially in teenage girls (Jack et al 2023). However, it is plausible to speculate that many of the patients diagnosed with tics in fact had FTLB, since it is well known that the incidence of FTLB dramatically increased during the pandemic and many of these patients were misdiagnosed with TS.…”

Section: Transient Effects Of Environment On Tic Severitymentioning

confidence: 99%

Tourette syndrome research highlights from 2023

Hartmann,

Andrén,

Atkinson-Clement

et al. 2024

F1000Res

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“…This increase was referred to as an additional ‘silent epidemic’ alongside the COVID-19 pandemic, and paroxysmal hyperkinetic movements accounted for 10/39 (26%) of emergency referrals for functional movement disorders [ 20 ]. A population-based study carried out in England documented a more than fourfold increase in teenage girls who developed tic-like behaviors during the COVID-19 pandemic, often in association with anxiety and/or other mental health co-morbidities [ 21 ].…”

Section: Introductionmentioning

confidence: 99%

Functional Tic-like Behaviors: From the COVID-19 Pandemic to the Post-Pandemic Era

Cavanna,

Spini,

Ferrari

et al. 2024

Healthcare

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During the COVID-19 pandemic, there have been multiple reports about an unforeseen surge in adolescents and young adults exhibiting sudden onset functional tic-like behaviors. This phenomenon has been mainly associated with the female gender and occasionally after exposure to social media content featuring similar patterns of functional tic-like behaviors. A significant portion of these individuals have been directed to specialist clinics for movement disorders with initial misdiagnoses of late-onset refractory Tourette syndrome. Distinguishing between rapid onset functional tic-like behaviors and neurodevelopmental tics as part of Tourette syndrome can be challenging; however, the differential diagnosis is facilitated by focusing on specific clinical and demographic factors, which we have explored in a systematic literature review. Compared to neurodevelopmental tics, functional tic-like behaviors typically present with a more abrupt and intense manifestation of symptoms, onset at a later age, higher prevalence among females, inability to suppress tics, coexisting anxiety and depression, and sometimes a history of exposure to social media content portraying tic-like behaviors of a similar nature. This novel manifestation of a functional neurological disorder may thus be viewed as an emerging neuropsychiatric condition potentially triggered/exacerbated by the psychosocial repercussions of the COVID-19 crisis.

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Impact of the COVID-19 pandemic on incidence of tics in children and young people: a population-based cohort study

Cited by 8 publications

References 32 publications

New‐onset functional tics during the COVID‐19 pandemic: Clinical characteristics of 105 cases from a single centre

New‐onset functional tics during the COVID‐19 pandemic: Clinical characteristics of 105 cases from a single centre

Tourette syndrome research highlights from 2023

Functional Tic-like Behaviors: From the COVID-19 Pandemic to the Post-Pandemic Era

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