Mind the Difference Between Primary Tics and Functional Tic‐like Behaviors

Müller-Vahl, Kirsten; Edwards, Mark

doi:10.1002/mds.28853

Cited by 10 publications

(20 citation statements)

References 12 publications

(30 reference statements)

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“…Simple phonic tics usually emerge after motor tic onset [ 15 ••, 17 ]. TS patients experience typical fluctuations in tic severity [ 15 ••, 18 ••], usually with a peak in tic severity during pre-adolescence followed by a decrease in severity by late adolescence [ 12 , 13 , 17 ]. Tics diminish to milder presentations or remit by adulthood in many TS patients [ 12 , 13 ].…”

Section: Phenomenology: Contrasting Functional Tic-like Behaviors And...mentioning

confidence: 99%

“…Patients with FTLB often also display rare manifestations of complex motor and phonic tics compared to TS patients. Copropraxia- (obscene gestures) and coprolalia-like (obscene words) behaviors, throwing objects, and behaviors potentially causing accidental self-harm are common in FTLB, whereas less than 20% of TS patients experience these types of symptoms [ 3 ••, 4 ••, 5 ••, 6 •, 9 •, 15 ••, 18 ••]. FTLB also disproportionately affect the limbs and trunk compared to TS [ 3 ••, 4 ••, 5 ••, 6 •, 9 •, 15 ••, 18 ••].…”

Section: Phenomenology: Contrasting Functional Tic-like Behaviors And...mentioning

confidence: 99%

“…Copropraxia- (obscene gestures) and coprolalia-like (obscene words) behaviors, throwing objects, and behaviors potentially causing accidental self-harm are common in FTLB, whereas less than 20% of TS patients experience these types of symptoms [ 3 ••, 4 ••, 5 ••, 6 •, 9 •, 15 ••, 18 ••]. FTLB also disproportionately affect the limbs and trunk compared to TS [ 3 ••, 4 ••, 5 ••, 6 •, 9 •, 15 ••, 18 ••]. Tic attacks are lengthy paroxysms of non-suppressible motor and phonic tics lasting minutes to hours, reported in only 8% of TS patients, but in between 36 and 100% of FTLB patients across studies [ 4 ••, 9 •, 20 ].…”

Section: Phenomenology: Contrasting Functional Tic-like Behaviors And...mentioning

confidence: 99%

“…Pre-pandemic research has suggested that tic attacks in TS are psychologically maintained, with affected patients reporting higher levels of tic-focused attention, comorbid anxiety and panic disorders [ 20 ]. As we discuss below, anxiety and panic disorder are also common comorbidities of FTLB [ 4 ••, 9 •, 15 ••, 18 ••]. FTLB can be socially reactive and directional with an extensive repertoire of variable behaviors that pose an additional facet of complexity than typically observed in TS [ 4 ••, 6 •, 8 •, 9 •, 18 ••].…”

Section: Phenomenology: Contrasting Functional Tic-like Behaviors And...mentioning

confidence: 99%

See 3 more Smart Citations

Sudden Onset Tic and Tic-Like Presentations in Older Adolescents and Adults

Berg

Pringsheim

Martino

2022

Curr Dev Disord Rep

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Purpose of Review The past 3 years have seen an unprecedented increase in patients with functional tic-like behaviors (FTLB), a previously rare form of functional movement disorder (FMD) that can be mistaken for Tourette syndrome (TS). This article contrasts the patient characteristics, phenomenology, risk factors, and comorbidities of FTLB and TS to define criteria for differential diagnosis. Clinical issues, treatments, theoretical explanations, and future research questions are discussed. Recent Findings FTLB predominately affect females, with a later onset of movements and vocalizations that are more complex, directional, severe, debilitating, and non-suppressible compared to TS. Psychosocial stressors from the pandemic, exposure to tic-content on social media, and comorbid anxiety and depression are etiological factors. Cognitive behavioral therapies appear to be effective treatment strategies. Summary Creation of standardized clinical practice guidelines for diagnosis and treatment of this now common FMD are recommended. Etiological explanations fit coherently within a biopsychosocial model of pathology.

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Section: Phenomenology: Contrasting Functional Tic-like Behaviors And...mentioning

confidence: 99%

Section: Phenomenology: Contrasting Functional Tic-like Behaviors And...mentioning

confidence: 99%

Section: Phenomenology: Contrasting Functional Tic-like Behaviors And...mentioning

confidence: 99%

Section: Phenomenology: Contrasting Functional Tic-like Behaviors And...mentioning

confidence: 99%

See 2 more Smart Citations

Sudden Onset Tic and Tic-Like Presentations in Older Adolescents and Adults

Berg

Pringsheim

Martino

2022

Curr Dev Disord Rep

View full text Add to dashboard Cite

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“… 27 In 97% of our patients with functional ‘Tourette-like’ behaviour, we identified maintaining factors including increased (loving and caring) attention from parents, partners, and friends at home and school, but also on social media (unpublished data). In order to achieve remission, not only early diagnosis is pivotal, 28 but also identification of maintaining—as well as triggering—factors.…”

mentioning

confidence: 99%

Reply: A call for caution: ‘stop that’ sentiments threaten tic research, healthcare and advocacy progress

Müller‐Vahl

Pisarenko

Jakubovski

et al. 2022

Brain

Self Cite

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Have We Forgotten What Tics Are? A Re‐Exploration of Tic Phenomenology in Youth with Primary Tics

Martino

Fletcher

Pringsheim

2023

Movement Disord Clin Pract

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Background The first systematic description of tics in a large sample was in 1978. Objectives To assess the phenomenology of tics in youth and investigate how age and sex influence tic phenomenology. Methods Children and adolescents with primary tic disorders have been prospectively included in our Registry in Calgary, Canada, since 2017. We examined tic frequency and distribution using the Yale Global Tic Severity Scale, differences between sexes, and changes in tic severity with age and with mental health comorbidities. Results A total of 203 children and adolescents with primary tic disorders were included (76.4% males; mean age = 10.7 years, 95% CI = 10.3–11.1). At first assessment, the most common simple motor tics were eye blinking (57%), head jerks/movements (51%), eye movements (48%) and mouth movements (46%); 86% had at least one simple facial tic. The most frequent complex motor tics were tic‐related compulsive behaviors (19%). Throat clearing was the most common simple phonic tic (42%); 5% only had coprolalia. Females had higher frequency and intensity of motor tics than males (P = 0.032 and P = 0.006, respectively), associated with greater tic‐related impairment (P = 0.045). Age was positively correlated with the Total Tic Severity Score (coefficient 0.54, P = 0.005), along with the number, frequency and intensity of motor tics but not with their complexity. Psychiatric comorbidities were associated with greater tic severity. Conclusions Our study suggests that age and sex affect clinical presentation in youth with tics. The phenomenology of tics in our sample was similar to the 1978 description of tics, and contrasts with functional tic‐like behaviors.

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Mind the Difference Between Primary Tics and Functional Tic‐like Behaviors

Cited by 10 publications

References 12 publications

Sudden Onset Tic and Tic-Like Presentations in Older Adolescents and Adults

Sudden Onset Tic and Tic-Like Presentations in Older Adolescents and Adults

Reply: A call for caution: ‘stop that’ sentiments threaten tic research, healthcare and advocacy progress

Have We Forgotten What Tics Are? A Re‐Exploration of Tic Phenomenology in Youth with Primary Tics

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