Sex differences in patients with Tourette syndrome

Abstract

Background Tourette syndrome (TS) is a neurodevelopmental disorder characterized by the presence of motor and phonic tics. It is at least three times more common in males compared with females; however, the clinical phenomenology between sexes has not been fully examined. We aimed to contrast the clinical features between males and females with TS and chronic tic disorder. Methods We studied 201 consecutive patients fulfilling the diagnostic criteria for TS, persistent (or chronic) motor and vocal tic disorder and provisional tic disorder that were considered within the TS spectrum disorder. We performed blinded evaluations of video-recordings and retrospectively reviewed the clinical charts of all patients. Results Age ranges between 4 and 65 years. Males represented 77.6% of patients in the cohort. Overall, no differences were observed in the frequency, distribution and complexity of tics between sexes, except for a higher frequency of attention-deficit/hyperactivity disorder (ADHD) (P = .003) among males. Patients younger than 18-years old, in addition to a higher frequency of ADHD (P = .026), males had a statistically higher frequency of complex motor tics (P = .049) and earlier age at onset (P = .072) than females in the multivariate regression analysis. However, these differences were lost in patients older than 18 years, due to increased complexity of tics in females with aging. Conclusions A sexual dimorphism was observed between patients with TS mainly before age of 18 years, suggesting an earlier onset of some types of tics and ADHD in males compared to females.

European Society for the Study of Tourette Syndrome 2022 criteria for clinical diagnosis of functional tic‐like behaviours: International consensus from experts in tic disorders

“…Another recent study in 201 individuals with tic disorders (age = 4–65 years) found that age at onset and frequency, distribution, and complexity of tics were also similar between sexes. Although mild differences were found in the group of patients younger than 18 years, these authors have suggested that tic severity, tic complexity, and related impairment may be slightly greater with age in women compared to men [28]. However, these small differences between males and females with TS do not allow for the confounding of TS and FTLBs in women, in view of strikingly different presentation and phenomenology (in terms of type and distribution of behaviours, number, frequency, intensity, and complexity) between the two conditions, regardless of sex.…”

Diagnosis and Management of Functional Tic-Like Phenomena

“…A second study (n = 148) reported a later onset age in girls, but the mean difference was only 1.2 years [ 25 ]. Most studies, including the largest one [ 33 ], found no significant sex difference in age of onset [ 34 , 35 , 36 , 37 , 38 ]. The only large, prospective study of youth beginning before tic onset found male predominance [ 30 ].…”

“…In summary, later onset in females is possible but unproven, and even the studies that reported a difference in age of onset found small differences, with mean onset by age 10. A recent blinded video review of 201 individuals found a statistically higher frequency of complex tics in males than in females [ 38 ].…”

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

“…Described differences in phenomenology between sexes have varied between studies. In a recent study of 201 individuals (age 4–65 years) with tic disorders, males younger than 18 years ( n = 118) had a greater complexity and severity of tics than females ( P = 0.049) and an earlier age at onset (mean age 5.9 versus 7.5 years old) 8 . These differences were not present in subjects older than 18.…”