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Kroeger MG, Thomsen T, Natteru PA. Adult-Onset Tics After Being Crushed by an Air Conditioner: A Case Report. Cureus 2023; 15:e45741. [PMID: 37876411 PMCID: PMC10591533 DOI: 10.7759/cureus.45741] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 09/19/2023] [Indexed: 10/26/2023] Open
Abstract
Tics are sudden, repetitive, non-rhythmic movements and/or vocalizations. Generally, tics begin during childhood as a part of Tourette syndrome (TS) and rarely have an onset during adulthood. We describe a 30-year-old male who presented with multiple motor and vocal tics two weeks following a closed head injury with alteration of consciousness as a result of being crushed against the wall by a 4,100-pound air-conditioning unit. He started having motor tics that developed in a rostrocaudal distribution, followed by simple and complex vocal tics. His tics increased in severity over several months following the injury until presentation. He was started on pimozide and received hyperbaric oxygen treatment which improved both motor and vocal tics.
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Affiliation(s)
| | - Teri Thomsen
- Movement Disorders, University of Iowa Hospitals and Clinics, Iowa City, USA
| | - Prashant A Natteru
- Movement Disorders, University of Iowa Hospitals and Clinics, Iowa City, USA
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Higgins JNP, Kirker S. Case report: Post-traumatic Tourette syndrome resolving with treatment of jugular venous narrowing; reconciling organic brain dysfunction following whiplash trauma with the absence of direct brain injury. Front Neurol 2023; 14:1179596. [PMID: 37342778 PMCID: PMC10277496 DOI: 10.3389/fneur.2023.1179596] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/04/2023] [Accepted: 05/02/2023] [Indexed: 06/23/2023] Open
Abstract
We describe a man aged 33 years who developed multiple symptoms, personality change, and a severe tic disorder following a road traffic accident, which were undiminished for 3 years until jugular venous narrowing between the styloid process of the skull and the transverse process of the C1 vertebra was treated by surgical decompression. Immediately following surgery, his abnormal movements almost completely resolved, with no regression in 5 years of follow-up. Vigorously debated at the time was whether or not his condition represented a functional disorder. Unrecognized throughout his illness, however, was a complaint of intermittent, profuse discharge of clear fluid from his nose that began on the day of the accident and continued up to the time of surgery, after which it was substantially reduced. This outcome reinforces the idea that jugular venous narrowing can cause or perpetuate a cerebrospinal fluid leak. It suggests that the interaction between these two pathological defects may have a profound effect on brain function in the absence of any demonstrable brain lesion. It invites a reevaluation of normal head and neck venous anatomy. It should strike a cautionary note in the diagnosis of functional illness. It invites exploration of a remediable structural cause for Tourette syndrome.
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Affiliation(s)
| | - Stephen Kirker
- Department of Rehabilitation Medicine, Addenbrooke’s Hospital, Cambridge, United Kingdom
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Nilles C, Amorelli G, Pringsheim TM, Martino D. "Unvoluntary" Movement Disorders: Distinguishing between Tics, Akathisia, Restless Legs, and Stereotypies. Semin Neurol 2023; 43:123-146. [PMID: 36854394 DOI: 10.1055/s-0043-1764164] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/02/2023]
Abstract
Tics, stereotypies, akathisia, and restless legs fall at different places on the spectrum of discrete, unwanted and potentially disabling motor routines. Unlike tremor, chorea, myoclonus, or dystonia, this subgroup of abnormal movements is characterized by the subject's variable ability to inhibit or release undesired motor patterns on demand. Though it may be sometimes clinically challenging, it is crucial to distinguish these "unvoluntary" motor behaviors because secondary causes and management approaches differ substantially. To this end, physicians must consider the degree of repetitiveness of the movements, the existence of volitional control, and the association with sensory symptoms, or cognitive-ideational antecedent. This review aims to summarize the current existing knowledge on phenomenology, diagnosis, and treatment of tics, stereotypies, akathisia, and restless leg syndrome.
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Affiliation(s)
- Christelle Nilles
- Department of Clinical Neurosciences, Cumming School of Medicine, University of Calgary, Calgary, Alberta, Canada
| | - Gabriel Amorelli
- Department of Clinical Neurosciences, Cumming School of Medicine, University of Calgary, Calgary, Alberta, Canada
| | - Tamara M Pringsheim
- Department of Clinical Neurosciences, Psychiatry, Pediatrics and Community Health Sciences, University of Calgary, Calgary, Alberta, Canada.,Mathison Centre for Mental Health Research and Education, Calgary, Alberta, Canada.,Hotchkiss Brain Institute, University of Calgary, Calgary, Alberta, Canada
| | - Davide Martino
- Department of Clinical Neurosciences, Cumming School of Medicine, University of Calgary, Calgary, Alberta, Canada.,Mathison Centre for Mental Health Research and Education, Calgary, Alberta, Canada.,Hotchkiss Brain Institute, University of Calgary, Calgary, Alberta, Canada
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Nilles C, Hartmann A, Roze E, Martino D, Pringsheim T. Tourette syndrome and other tic disorders of childhood. HANDBOOK OF CLINICAL NEUROLOGY 2023; 196:457-474. [PMID: 37620085 DOI: 10.1016/b978-0-323-98817-9.00002-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 08/26/2023]
Abstract
Tics are repetitive, patterned, and nonrhythmic movements or vocalizations/audible sounds that are misplaced in context. Phenomenology and characteristics of tics (e.g., premonitory urge, suppressibility) differentiate them from compulsions, stereotypies, functional tic-like behaviors, and other types of hyperkinetic movement disorders. With a prevalence of approximately 1% in school-aged boys, Tourette syndrome (TS) is considered a common childhood-onset neurodevelopmental disorder, defined by the combination of at least two motor tics and at least one phonic tic lasting more than 1 year. TS is a highly heritable disorder, with a wide spectrum of severity. In some individuals, tics can cause pain, distress, functional impairment, or stigmatization. About 90% of individuals with TS have at least one mental health comorbidity (attention-deficit/hyperactivity disorder, obsessive-compulsive disorder, anxiety/depressive disorders). These comorbidities significantly impact patients' quality of life and must therefore be screened and managed accordingly in this population. Treatment of tics is based on behavioral therapies targeting tics (habit reversal training included in the comprehensive behavioral intervention for tics, and exposure and response prevention for tics), in association with medication if needed (e.g., alpha-2-agonists, second-generation antipsychotics). Deep brain stimulation is considered an experimental option in the most severe, treatment-resistant patients. In adulthood, less than 25% of individuals still have moderate or severe tics.
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Affiliation(s)
- Christelle Nilles
- Department of Clinical Neurosciences, Psychiatry, Pediatrics and Community Health Sciences, University of Calgary, Calgary, AB, Canada; Department of Neurology, Pitié-Salpêtrière Hospital, Paris, France
| | - Andreas Hartmann
- Department of Neurology, Pitié-Salpêtrière Hospital, Paris, France; National Reference Center for Tourette Disorder, Pitié-Salpêtrière Hospital, Paris, France
| | - Emmanuel Roze
- Department of Neurology, Pitié-Salpêtrière Hospital, Paris, France; Faculty of Medicine of Sorbonne University, Institut du Cerveau et de la Moelle épinière, Paris, France
| | - Davide Martino
- Department of Clinical Neurosciences, Cumming School of Medicine, University of Calgary, Calgary, AB, Canada; Hotchkiss Brain Institute, University of Calgary, Calgary, AB, Canada
| | - Tamara Pringsheim
- Department of Clinical Neurosciences, Psychiatry, Pediatrics and Community Health Sciences, University of Calgary, Calgary, AB, Canada; Hotchkiss Brain Institute, University of Calgary, Calgary, AB, Canada.
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Fremont R, Dworkin J, Manoochehri M, Krueger F, Huey E, Grafman J. Damage to the dorsolateral prefrontal cortex is associated with repetitive compulsive behaviors in patients with penetrating brain injury. BMJ Neurol Open 2022; 4:e000229. [PMID: 35519903 PMCID: PMC9020295 DOI: 10.1136/bmjno-2021-000229] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/26/2021] [Accepted: 03/18/2022] [Indexed: 11/03/2022] Open
Abstract
Background Damage to cortico-striato-thalamo-cortical (CSTC) circuits is associated with the development of repetitive behaviours in animals and humans. However, the types of repetitive behaviours that are developed after injury to these structures are poorly defined. This study examines the effect of damage to separate elements of CSTC circuits sustained by veterans of the Vietnam War on obsessions, compulsions, and tics. Methods We performed partial correlations (correcting for cognition, age, education, and global brain damage) between volume loss from traumatic brain injury in specific elements of CSTC circuits (lateral and medial orbitofrontal and dorsolateral prefrontal cortices, anterior cingulate cortex, thalamus, and basal ganglia) and scores on a modified version of the Yale-Brown Obsessive Compulsive Scale Symptom Checklist and the Yale Global Tic Severity Scale in 83 Vietnam war veterans with penetrating brain injuries at different sites throughout the brain. Results We found that volume loss in the left dorsolateral prefrontal cortex was associated with the development of compulsive behaviours (r=0.32, padj<0.05) whereas volume loss in the basal ganglia was associated with the development of tics (r=0.33, padj<0.05). Conclusion Our findings indicate that damage to specific CSTC elements can be associated with the development of compulsive behaviours and tics that are not necessarily accompanied by obsessions.
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Affiliation(s)
- Rachel Fremont
- Department of Psychiatry, Columbia University Medical Center, New York, New York, USA
| | - Jordan Dworkin
- Department of Psychiatry, Columbia University Medical Center, New York, New York, USA
- Department of Psychiatry, New York State Psychiatric Institute, New York, New York, USA
| | - Masood Manoochehri
- Taub Insitute, Columbia University Medical Center, New York, New York, USA
| | - Frank Krueger
- Molecular Neuroscience Department, George Mason University, Fairfax, Virginia, USA
- Department of Psychology, George Mason University, Fairfax, Virginia, USA
| | - Edward Huey
- Department of Psychiatry, Columbia University Medical Center, New York, New York, USA
- Department of Neurology, Columbia University, New York, New York, USA
| | - Jordan Grafman
- Brain Injury Research, Rehabilitation Institute of Chicago, Chicago, Illinois, USA
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Badar SA, Radhakrishnan R, Golomb MR. The Impact of Pediatric Basal Ganglia Stroke on Mental Health in Children: Report of 2 Cases. Child Neurol Open 2021; 7:2329048X20979248. [PMID: 33403220 PMCID: PMC7745549 DOI: 10.1177/2329048x20979248] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/20/2020] [Revised: 10/05/2020] [Accepted: 11/07/2020] [Indexed: 12/02/2022] Open
Abstract
Background: The impact of basal ganglia stroke on mental health is better described in adults than in children. We report 2 children with significant mental health issues after basal ganglia stroke. Case Reports: Patient 1, an 8-year-old boy, had mild anxiety before his left basal ganglia stroke. Post-stroke, he developed severe anxiety, obsessions, depression, and attention deficit hyperactivity disorder, in addition to a right hemiplegia and some mild chorea. He gradually improved over 3 years with psychiatric care and medication but continued to have residual symptoms. Patient 2, a 10-year-old boy, had no history of mental health issues before his right basal ganglia stroke. Post-stroke, he developed significant anxiety and mild depression, along with a left hemiplegia. He improved over 9 months and returned to his mental health baseline. Conclusions: Mental health issues after basal ganglia stroke in children can be significant, and recovery can take months to years.
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Affiliation(s)
- Sidrah A Badar
- Division of Pediatric Neurology, Department of Neurology, Indiana University School of Medicine, Indianapolis, IN, USA
| | - Rupa Radhakrishnan
- Division of Pediatric Neuroradiology, Department of Radiology and Imaging Sciences, Indiana University School of Medicine, Indianapolis, IN, USA
| | - Meredith R Golomb
- Division of Pediatric Neurology, Department of Neurology, Indiana University School of Medicine, Indianapolis, IN, USA
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Li X, Yu J, Ma D, Weng X. Edaravone Improves the Post-traumatic Brain Injury Dysfunction in Learning and Memory by Modulating Nrf2/ARE Signal Pathway. Clinics (Sao Paulo) 2021; 76:e3131. [PMID: 34878029 PMCID: PMC8610218 DOI: 10.6061/clinics/2021/e3131] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/19/2021] [Accepted: 09/16/2021] [Indexed: 01/02/2023] Open
Abstract
OBJECTIVES To investigate the molecular mechanism of edaravone (EDA) in improving the post-traumatic brain injury (TBI) dysfunction in learning and memory. METHODS In vitro and in vivo TBI models were established using hydrogen peroxide (H2O2) treatment for hippocampal nerve stem cells (NSCs) and surgery for rats, followed by EDA treatment. WST 1 measurement, methylthiazol tetrazolium assay, and flow cytometry were performed to determine the activity, proliferation, and apoptosis of NSCs, and malondialdehyde (MDA), lactic dehydrogenase (LDH), and reactive oxygen species (ROS) detection kits were used to analyze the oxides in NSCs. RESULTS Following EDA pretreatment, NSCs presented with promising resistance to H2O2-induced oxidative stress, whereas NSCs manifested significant increases in activity and proliferation and a decrease in apoptosis. Meanwhile, for NSCs, EDA pretreatment reduced the levels of MDA, LDH, and ROS, with a significant upregulation of Nrf2/antioxidant response element (ARE) signaling pathway, whereas for EDA-treated TBI rats, a significant reduction was observed in the trauma area and injury to the hippocampus, with improvement in memory and learning performance and upregulation of Nrf2/ARE signaling pathway. CONCLUSIONS EDA, by regulating the activity of Nrf2/ARE signal pathway, can improve the TBI-induced injury to NSCs and learning and memory dysfunction in rats.
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Affiliation(s)
| | - Jing Yu
- Corresponding author. E-mail:
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Daubigney A, Rénéric JP, Pradier S, Maciel F, Guehl D, Burbaud P. A single case of tics secondary to gunshot wound. Rev Neurol (Paris) 2020; 177:151-152. [PMID: 32713737 DOI: 10.1016/j.neurol.2020.04.030] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/21/2020] [Accepted: 04/28/2020] [Indexed: 10/23/2022]
Affiliation(s)
- A Daubigney
- Service des Explorations Fonctionnelles du Système Nerveux, CHU de Bordeaux, 146, rue Léo-Saignat, 33076 Bordeaux, France.
| | - J P Rénéric
- Service de Pédo-Psychiatrie, Centre Hospitalier Charles-Perrens, rue de la Béchade, 33076 Bordeaux, France
| | - S Pradier
- Service des Explorations Fonctionnelles du Système Nerveux, CHU de Bordeaux, 146, rue Léo-Saignat, 33076 Bordeaux, France
| | - F Maciel
- Service des Explorations Fonctionnelles du Système Nerveux, CHU de Bordeaux, 146, rue Léo-Saignat, 33076 Bordeaux, France
| | - D Guehl
- Service des Explorations Fonctionnelles du Système Nerveux, CHU de Bordeaux, 146, rue Léo-Saignat, 33076 Bordeaux, France; Institut des Maladies Neurodégénératives (IMN), CNRS U-5293, Université de Bordeaux, 146, rue Léo-Saignat, 33076 Bordeaux, France
| | - P Burbaud
- Service des Explorations Fonctionnelles du Système Nerveux, CHU de Bordeaux, 146, rue Léo-Saignat, 33076 Bordeaux, France; Institut des Maladies Neurodégénératives (IMN), CNRS U-5293, Université de Bordeaux, 146, rue Léo-Saignat, 33076 Bordeaux, France
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