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Grossen SC, Arbuckle AL, Bihun EC, Koller JM, Song DY, Reiersen AM, Schlaggar BL, Greene DJ, Black KJ. We've all been wrong about provisional tic disorder. Compr Psychiatry 2024; 134:152510. [PMID: 38941871 PMCID: PMC11373539 DOI: 10.1016/j.comppsych.2024.152510] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/30/2024] [Revised: 06/10/2024] [Accepted: 06/13/2024] [Indexed: 06/30/2024] Open
Abstract
BACKGROUND Provisional Tic Disorder (PTD) is common in childhood. The received wisdom among clinicians is that PTD is short-lived and mild, with at most a few tics, and rarely includes complex tics, premonitory phenomena or comorbid illnesses. However, such conclusions come from clinical experience, with biased ascertainment and limited follow-up. METHODS Prospective study of 89 children with tics starting 0-9 months ago (median 4 months), fewer than half from clinical sources. Follow-up at 12 (± 24, 36, 48) months after the first tic. RESULTS At study entry, many children had ADHD (39), an anxiety disorder (27), OCD (9) or enuresis (17). All had at least two current tics, with a mean total since onset of 6.9 motor and 2.0 phonic tics. Forty-one had experienced a complex tic, and 69 could suppress some tics. Tics were clinically meaningful: 64 had tics severe enough for a clinical trial, and 76 families sought medical attention for the tics. At 12 months, 79 returned, and 78 still had tics. Of these, 29 manifested no tics during history and extended examination, but only via audio-visual monitoring when the child was seated alone. Only 12/70 now had plans to see a doctor for tics. Most who returned at 2-4 years still had tics known to the child and family, but medical impact was low. CONCLUSIONS Our results do not contradict previous data, but overturn clinical lore. The data strongly argue against the longstanding but arbitrary tradition of separating tic disorders into recent-onset versus chronic.
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Affiliation(s)
- Sarah C Grossen
- Departments of Psychiatry and Neurology, Washington University in St. Louis, St. Louis, MO, United States of America
| | - Amanda L Arbuckle
- Department of Psychiatry, Washington University in St. Louis, St. Louis, MO, United States of America
| | - Emily C Bihun
- Department of Psychiatry, Washington University in St. Louis, St. Louis, MO, United States of America
| | - Jonathan M Koller
- Department of Psychiatry, Washington University in St. Louis, St. Louis, MO, United States of America
| | - David Y Song
- Departments of Psychiatry and Neurology, Washington University in St. Louis, St. Louis, MO, United States of America
| | - Angela M Reiersen
- Department of Psychiatry, Washington University in St. Louis, St. Louis, MO, United States of America
| | - Bradley L Schlaggar
- Kennedy Krieger Institute, Baltimore, MD, and Departments of Neurology and Pediatrics, The Johns Hopkins University School of Medicine, Baltimore, MD, United States of America
| | - Deanna J Greene
- Department of Cognitive Science, University of California San Diego, La Jolla, CA, United States of America
| | - Kevin J Black
- Departments of Psychiatry, Neurology, Radiology, and Neuroscience, Washington University in St. Louis, St. Louis, MO, United States of America.
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Systematic Review and Meta-Analysis of Tourette Syndrome Prevalence; 1986 to 2022. Pediatr Neurol 2022; 137:6-16. [PMID: 36182698 DOI: 10.1016/j.pediatrneurol.2022.08.010] [Citation(s) in RCA: 12] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/15/2022] [Revised: 08/23/2022] [Accepted: 08/25/2022] [Indexed: 11/21/2022]
Abstract
BACKGROUND Tourette syndrome (TS) is a disorder characterized by a history of multiple motor tics and the emergence of at least one vocal tic during a period of the disorder. The current investigation sought to clarify the prevalence statistics for TS using a systematic review and meta-analysis. METHODS This systematic review and meta-analysis covered the period between 1986 and 2022. Embase, Scopus, PubMed, Web of Science, and Google Scholar were searched to locate articles pertinent to the study topic. The I2 index was used to examine the heterogeneity of the studies, and a comprehensive meta-analysis was employed to analyze the data. RESULTS Ultimately, 30 studies (39 outcomes) were included in the meta-analysis and systematic review. The results showed the global prevalence of TS to be 0.5% (95% confidence interval [CI], 0.3% to 0.8%), with the highest rate of spread observed in the Americas at 0.6% (95% CI, 0.2% to 1.6 %). Analyzing the subgroups of the sample revealed that the highest prevalence was associated with the population of children and adolescents at 0.7% (95% CI, 0.4% to 1.4%) and males at 0.5% (95% CI, 0.2% to 1.0%). CONCLUSIONS This comprehensive review and meta-analysis revealed that the prevalence of TS worldwide is sufficiently high, such that attention of medical specialists and health policy makers is warranted.
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Mohammadi MR, Badrfam R, Khaleghi A, Ahmadi N, Hooshyari Z, Zandifar A. Lifetime Prevalence, Predictors and Comorbidities of Tic Disorders: A Population-Based Survey of Children and Adolescents in Iran. Child Psychiatry Hum Dev 2022; 53:1036-1046. [PMID: 33966152 DOI: 10.1007/s10578-021-01186-7] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 04/30/2021] [Indexed: 10/21/2022]
Abstract
In this population-based survey, we have evaluated the lifetime prevalence of tic disorders and related sociodemographic factors and comorbidities of them. The data obtained from face-to-face interviews with 29,885 children and adolescents aged 6-18 years. We used the multistage cluster sampling method and a cross-sectional design. Tic disorders and other psychiatric disorders were assessed using the Persian version of the Kiddie Schedule for Affective Disorders and Schizophrenia-Present and Lifetime Version (K-SADS-PL). The lifetime prevalence of tic disorders was 1.5% (95% CI (1.3-1.7%)). The highest prevalence was in the age range of 15-18 years old with 1.9% (95% CI (1.6-2.3%)).57.7% (95% CI 51.8-63.3%) of patients with tic disorders had comorbidity with other psychiatric disorders. Increasing the prevalence of tic disorder with increasing age among Iranian children and adolescents, emphasizes the need to pay more attention to use of pharmacological and non-pharmacological treatments and increase education to families in this regard.
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Affiliation(s)
- Mohammad Reza Mohammadi
- Psychiatry and Psychology Research Center, Roozbeh Hospital, Tehran University of Medical Sciences, Tehran, Iran
| | - Rahim Badrfam
- Psychiatry and Psychology Research Center, Roozbeh Hospital, Tehran University of Medical Sciences, Tehran, Iran.
| | - Ali Khaleghi
- Psychiatry and Psychology Research Center, Roozbeh Hospital, Tehran University of Medical Sciences, Tehran, Iran
| | - Nastaran Ahmadi
- Yazd Cardiovascular Research Center, Shahid Sadoughi University of Medical Sciences, Yazd, Iran
| | - Zahra Hooshyari
- Psychiatry and Psychology Research Center, Roozbeh Hospital, Tehran University of Medical Sciences, Tehran, Iran
| | - Atefeh Zandifar
- Social Determinants of Health Research Center (SDH), Alborz University of Medical Sciences, Karaj, Iran
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Garris J, Quigg M. The female Tourette patient: Sex differences in Tourette Disorder. Neurosci Biobehav Rev 2021; 129:261-268. [PMID: 34364945 DOI: 10.1016/j.neubiorev.2021.08.001] [Citation(s) in RCA: 24] [Impact Index Per Article: 8.0] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/12/2021] [Revised: 07/07/2021] [Accepted: 08/01/2021] [Indexed: 11/29/2022]
Abstract
Tourette Disorder (TD) is a male predominant neurodevelopmental disorder characterized by tics and frequent psychiatric comorbidities. Girls with TD have later peak symptoms, less remission with age, and worse impairment from tics, particularly in adulthood. Female TD patients are less likely to have Attention Deficit Hyperactivity Disorder and more likely to have anxiety and mood disorders. Hyperandrogenism is associated with TD in both sexes, and neuroanatomic sexual dimorphism is reduced in adult TD patients. Some women report catamenial tics, which may relate to estrogen withdrawal or rises in allopregnanolone. Limited data suggest that several neuroanatomic alterations present in boys with TD are not present in girls with TD. Female sex predicts better response to haloperidol. Further research into female tic pathophysiology may influence sex-specific treatment development.
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Affiliation(s)
- Jordan Garris
- Department of Neurology, University of Virginia, Box 800394, Charlottesville, VA 22908-0394, United States; Department of Pediatrics, University of Virginia, United States.
| | - Mark Quigg
- Department of Neurology, University of Virginia, Box 800394, Charlottesville, VA 22908-0394, United States
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Ueda K, Black KJ. A Comprehensive Review of Tic Disorders in Children. J Clin Med 2021; 10:2479. [PMID: 34204991 PMCID: PMC8199885 DOI: 10.3390/jcm10112479] [Citation(s) in RCA: 24] [Impact Index Per Article: 8.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/08/2021] [Revised: 05/28/2021] [Accepted: 05/31/2021] [Indexed: 01/13/2023] Open
Abstract
Tics are characterized by sudden, rapid, recurrent, nonrhythmic movement or vocalization, and are the most common movement disorders in children. Their onset is usually in childhood and tics often will diminish within one year. However, some of the tics can persist and cause various problems such as social embarrassment, physical discomfort, or emotional impairments, which could interfere with daily activities and school performance. Furthermore, tic disorders are frequently associated with comorbid neuropsychiatric symptoms, which can become more problematic than tic symptoms. Unfortunately, misunderstanding and misconceptions of tic disorders still exist among the general population. Understanding tic disorders and their comorbidities is important to deliver appropriate care to patients with tics. Several studies have been conducted to elucidate the clinical course, epidemiology, and pathophysiology of tics, but they are still not well understood. This article aims to provide an overview about tics and tic disorders, and recent findings on tic disorders including history, definition, diagnosis, epidemiology, etiology, diagnostic approach, comorbidities, treatment and management, and differential diagnosis.
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Affiliation(s)
- Keisuke Ueda
- Department of Neurology, Washington University School of Medicine, St. Louis, MO 63110, USA;
| | - Kevin J. Black
- Department of Neurology, Washington University School of Medicine, St. Louis, MO 63110, USA;
- Department of Psychiatry, Washington University School of Medicine, St. Louis, MO 63110, USA
- Department of Radiology, Washington University School of Medicine, St. Louis, MO 63110, USA
- Department of Neuroscience, Washington University School of Medicine, St. Louis, MO 63110, USA
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Malik O. Commentary: What is unsought will go undetected - a commentary on Rodin et al. (2020). Child Adolesc Ment Health 2021; 26:54-55. [PMID: 32930452 DOI: 10.1111/camh.12401] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 06/02/2020] [Indexed: 11/30/2022]
Abstract
Rodin et al.'s study (2020) on the belief, knowledge and attitudes about tics amongst health professionals in Uganda is a preliminary yet an important step towards challenging the current thinking amongst clinicians and academics working with tics, which is that tics are hardly seen in or are absent in the sub-Saharan African population and it has been psotulated that this phenomenon is considered to be explained by genetics.
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Affiliation(s)
- Osman Malik
- TANDeM (Tourette and Neurodevelopmental Movement Disorders) Service, Evelina London Children's Hospital, St Thomas' Hospital, London, UK
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Chutko LS, Surushkina SY, Yakovenko EA, Anisimova TI, Didur MD, Chekalova SA. [Cognitive disturbances in children with chronic tics and their treatment]. Zh Nevrol Psikhiatr Im S S Korsakova 2019; 119:24-31. [PMID: 31626167 DOI: 10.17116/jnevro201911908124] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
AIM To clarify the severity of cognitive disturbances in children with chronic tics and to evaluate the efficacy of cortexin as part of complex therapy in the treatment of this pathology. MATERIAL AND METHODS The main study group included 50 children, aged 6-8 years, with chronic motor tics. Twenty patients of these group received phenibut and 30 patients received cortexin in addition to phenibut. The comparison group consisted of 30 children with transient tics, aged 6-8 years, the control group consisted of 40 children of the same age without tics and other neuropsychiatric disorders. Clinical assessment of tick manifestations and their frequency was performed using the Tourette Syndrome Global Scale (TSGS), neurological examination, electroencephalography. Severity of asthenic and cognitive disorders was evaluated using the Subjective Asthenia Scale (MFI-20), the memorization technique by A.R. Luria and the TOVA test. RESULTS AND CONCLUSION Children with chronic tics show signs of asthenia, they are characterized by a higher level of inattention and significantly lower levels of long-term memory compared to children from the comparison group and the control group. The level of impulsivity in children with chronic tics is significantly higher than in the control group but significantly lower than in children in the comparison group. A comparative analysis of EEG data in children with chronic tics reveals the following significant differences from the control and comparison groups: a higher amplitude and higher values of the peak frequency of the alpha-rhythm in the posterior regions of both hemispheres, a significant increase in the alpha-range of the frontal temporal leads of both hemispheres. Complex therapy with the addition of cortexin significantly improves treatment efficacy: improvement is noted in 60,0% of patients in monotherapy and in 83.3% of patients in complex therapy.
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Affiliation(s)
- L S Chutko
- N. Bekhtereva Institute of Human Brain Russian Academy of Sciences, St. Petersburg, Russia
| | - S Yu Surushkina
- N. Bekhtereva Institute of Human Brain Russian Academy of Sciences, St. Petersburg, Russia
| | - E A Yakovenko
- N. Bekhtereva Institute of Human Brain Russian Academy of Sciences, St. Petersburg, Russia
| | - T I Anisimova
- N. Bekhtereva Institute of Human Brain Russian Academy of Sciences, St. Petersburg, Russia
| | - M D Didur
- N. Bekhtereva Institute of Human Brain Russian Academy of Sciences, St. Petersburg, Russia
| | - S A Chekalova
- Privolzhsky Research Medical University, Nizny Novgorod,Russia
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Chutko LS, Surushkina SY, Anisimova TI. Emotional disorders in adolescents with Tourette's syndrome and in their mothers. Zh Nevrol Psikhiatr Im S S Korsakova 2018; 118:56-59. [DOI: 10.17116/jnevro201811811156] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
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