Multiple neck operations in a patient with severe motor tics because of Tourette's syndrome: a case report

Cervical Spinal Fracture Caused by Untreated Tourette Syndrome: A Case Report

Cervical myelopathy can occur in Tourette syndrome patients with severe motor tics showing repetitive and violent neck movements. However, motor tics causing spinal fractures have been rarely reported. A 15-year-old girl presented at our clinic, complaining of recent development of motor weakness of all 4 extremities. She had untreated motor tics involving the neck. Computed tomography and magnetic resonance imaging findings suggested cervical spinal fractures and myelopathy. After diagnosing of Tourette syndrome, medical and psychologic therapies were started. Her motor tics were well controlled, and no complications in the patient's daily life were observed later. Cervical radiography taken at a 9-month follow-up showed bony healings of the fractured cervical spines. Uncontrolled severe motor tics may cause spinal fractures. Conservative treatments would suffice for proper control of these tics and stabilize the spine, and considered as initial treatment in patients with Tourette syndrome.

Tourette syndrome increases risk of bone fractures: a population-based cohort study

This study assesses the risk of fractures among children with Tourette syndrome (TS), and identifies the effects of comorbidities and antipsychotics. We randomly sampled the claims data of 1 million enrollees in the National Health Insurance program of Taiwan, and identified 1258 children with TS diagnosed between 2000 and 2010. Additionally, 12,580 children without TS who were frequency matched for sex, age, residential area, parental occupation, and index year were identified for comparison. The children's cases were followed until December 31, 2010, or censored to ascertain incident fractures cases and associations with comorbidities of attention-deficit/hyperactivity disorder (ADHD) or obsessive-compulsive disorder (OCD) and treatments with antipsychotics, antidepressants, or clonidine. The TS cohort had a 1.27-fold higher incidence of fractures than did the comparison cohort (190.37 vs. 149.94 per 10,000 person-years), with an adjusted hazard ratio (HR) of 1.28 [95% confidence interval (CI) 1.06-1.55] based on multivariable Cox regression analysis. This increased risk of fractures was apparent for fractures of the skull, neck, and spine. Comorbid ADHD and OCD did not result in an additional risk of fractures. The children without both ADHD and OCD were also at a higher risk of fractures, indicating that TS alone increases the risk of fractures. The children taking antipsychotics had a reduced risk of fractures, and the adjusted HR decreased to 1.17 (95% CI 0.90-1.52). Children with TS have an increased risk of fractures. ADHD and OCD do not increase the risk further.