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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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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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Black KJ, Kim S, Yang NY, Greene DJ. Course of tic disorders over the lifespan. CURRENT DEVELOPMENTAL DISORDERS REPORTS 2021; 8:121-132. [PMID: 34178575 PMCID: PMC8223879 DOI: 10.1007/s40474-021-00231-3] [Citation(s) in RCA: 20] [Impact Index Per Article: 6.7] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 03/23/2021] [Indexed: 12/20/2022]
Abstract
PURPOSE OF REVIEW To summarize and update information on the course of tic disorders from childhood through later life. RECENT FINDINGS Tics tend to improve substantially over the first year after they appear. However, contrary to widespread opinion, tics usually last longer than one year, though usually at minimal severity. Tics often wane to clinical insignificance over the teen years, possibly resurging occasionally over the lifespan. However, in an important minority of patients, tics remain clinically relevant throughout life. Tics rarely first come to clinical attention later in adulthood, but new reports describe additional such cases. SUMMARY Recent publications have shown tics to persist past a few months more often than previously thought, though often at minimal severity, and recurrence after an asymptomatic period is common. The safety and efficacy of behavior therapy for tics, together with prospective indicators of early prognosis, make feasible the possibility of bettering the lifetime course of tic disorders with early intervention.
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Affiliation(s)
- Kevin J. Black
- Department of Psychiatry, Washington University in St. Louis School of Medicine, St. Louis, Missouri, 63110
- Department of Neurology, Washington University in St. Louis School of Medicine, St. Louis, Missouri, 63110
- Department of Radiology Washington University in St. Louis School of Medicine, St. Louis, Missouri, 63110
- Department of Neurosdence Washington University in St. Louis School of Medicine, St. Louis, Missouri, 63110
| | - Soyoung Kim
- Department of Psychiatry, Washington University in St. Louis School of Medicine, St. Louis, Missouri, 63110
| | - Nancy Y. Yang
- Department of Psychiatry, Washington University in St. Louis School of Medicine, St. Louis, Missouri, 63110
| | - Deanna J. Greene
- Department of Cognitive Science, University of California, San Diego, La Jolla, California, 92093
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Kim CY, Petersen MS, Eliasen EH, Defazio G, Greene P, Jinnah HA, Tijssen MAJ, Louis ED. Involuntary Thumb Flexion on Neurological Examination: An Unusual Form of Upper Limb Dystonia in the Faroe Islands. TREMOR AND OTHER HYPERKINETIC MOVEMENTS (NEW YORK, N.Y.) 2019; 9:tre-09-686. [PMID: 31440418 PMCID: PMC6702791 DOI: 10.7916/tohm.v0.686] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Subscribe] [Scholar Register] [Received: 06/18/2019] [Accepted: 07/23/2019] [Indexed: 12/25/2022]
Abstract
Background The prevalence of dystonia varies worldwide. A prior report suggested a high prevalence of focal dystonia in the Faroese population, possibly reflecting a founder effect. During standardized neurological examination as part of an ongoing neuroepidemiologic study in the Faroe Islands, we noted an unusual phenomenon of thumb flexion during repetitive hand movements in a subset of subjects and sought to define its phenomenology. Methods We requested commentary from a panel of dystonia experts regarding the phenomenology of the movements. These experts reviewed the videotaped neurological examination. Results Among the experts, dystonia was the leading diagnosis. Alternate causes were considered, but deemed less likely. Discussion Diagnosis of dystonia requires careful clinical assessment and consideration of associated features. We report a novel form of dystonia, not previously described to our knowledge, in this isolated population. Further studies of dystonia prevalence in the Faroe Islands are merited to characterize its burden in this population and its specific clinical characteristics.
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Affiliation(s)
- Christine Y Kim
- Department of Neurology, Yale School of Medicine, Yale University, New Haven, CT, USA.,Center for Neuroepidemiology and Clinical Neurological Research, Yale School of Medicine, Yale University, New Haven, CT, USA
| | - Maria Skaalum Petersen
- Department of Occupational Medicine and Public Health, The Faroese Hospital System, Torshavn, FO.,Centre for Health Science, Faculty of Health Sciences, University of the Faroe Islands, Tórshavn, FO
| | - Eina H Eliasen
- Department of Occupational Medicine and Public Health, The Faroese Hospital System, Torshavn, FO
| | - Giovanni Defazio
- Department of Medical Sciences and Public Health, Neurology Unit, University of Cagliari, Cagliari, IT
| | - Paul Greene
- Mount Sinai School of Medicine, Movement Disorders Division, New York, NY, USA
| | - Hyder A Jinnah
- Departments of Neurology, Human Genetics and Pediatrics, Emory University, Atlanta, GA, USA
| | - Marina A J Tijssen
- Department of Neurology, University Medical Centre Groningen, University of Groningen, Groningen, NL
| | - Elan D Louis
- Department of Neurology, Yale School of Medicine, Yale University, New Haven, CT, USA.,Center for Neuroepidemiology and Clinical Neurological Research, Yale School of Medicine, Yale University, New Haven, CT, USA.,Department of Chronic Disease Epidemiology, Yale School of Public Health, Yale University, New Haven, CT, USA
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Ricketts EJ, Wu MS, Leman T, Piacentini J. A Review of Tics Presenting Subsequent to Traumatic Brain Injury. CURRENT DEVELOPMENTAL DISORDERS REPORTS 2019; 6:145-158. [PMID: 31984203 DOI: 10.1007/s40474-019-00167-9] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/13/2022]
Abstract
Purpose of review This review summarizes case reports of patients with tics emerging subsequent to traumatic brain injury (TBI), with respect to demographics, post-TBI symptoms, tic onset latency and topography, clinical history, neuroimaging results and treatment outcome. Recent findings Patients were 22 adults and 3 youth. Trauma onset appeared to fall mostly in adulthood. Two-thirds of patients were male and head trauma was related to motor vehicle accidents in most cases. Loss of consciousness was reported in just below half (48.0%) of cases. Associated physical and cognitive symptoms (e.g., impaired memory, reduced sensory perception, poor balance, muscle weakness, attention problems, aggression/impulsivity, obsessions and compulsions, depression and anxiety) were commonly reported. The latency between head trauma and tic onset varied, but generally ranged from one day post-trauma to approximately one year post-trauma. Sole presentation of motor tics was common, with rostral to caudal development of motor tics in other cases. Simple and/or complex vocal tics were present in several cases, often emerging after motor tics. Post-trauma obsessive-compulsive symptoms were noted in five cases (20.0%). A personal or family history of tics was reported in four cases. Damage to the basal ganglia, ventricular system, and temporal region was observed across ten patients (40.0%). Pharmacological intervention varied, with tic symptoms deemed to have significantly or somewhat improved in 12 cases (48.0%). A comparison of post-TBI symptoms in youth with head trauma history relative to those with peripheral injury suggests tic symptoms are not a common post-TBI symptom in youth. Summary Ultimately, there has been limited study on the link between traumatic brain injury and tic expression, and methodological issues preclude the ability to draw definitive conclusions regarding this relationship. Nevertheless, findings do suggest there may be heterogeneity in brain dysfunction associated with tic expression. Future case reports should utilize more systematic and thorough assessment of TBI and tics using validated measures, evaluate medication effects using single-case designs, and perform more longitudinal follow-up of cases with repeated neuroimaging.
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Affiliation(s)
- Emily J Ricketts
- Division of Child and Adolescent Psychiatry, University of California, Los Angeles, Los Angeles, CA, 90024
| | - Monica S Wu
- Division of Child and Adolescent Psychiatry, University of California, Los Angeles, Los Angeles, CA, 90024
| | - Talia Leman
- Division of Child and Adolescent Psychiatry, University of California, Los Angeles, Los Angeles, CA, 90024
| | - John Piacentini
- Division of Child and Adolescent Psychiatry, University of California, Los Angeles, Los Angeles, CA, 90024
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Kim DD, Barr AM, Chung Y, Yuen JWY, Etminan M, Carleton BC, White RF, Honer WG, Procyshyn RM. Antipsychotic-Associated Symptoms of Tourette Syndrome: A Systematic Review. CNS Drugs 2018; 32:917-938. [PMID: 30121819 DOI: 10.1007/s40263-018-0559-8] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/01/2023]
Abstract
BACKGROUND Although antipsychotics are used to treat Tourette syndrome, there have been reports of paradoxical induction of tics by first- and second-generation antipsychotics. OBJECTIVE The objective of this systematic review was to better characterize tics as the potential adverse effect of antipsychotics. METHODS A literature search was performed, with no language restriction, using the MEDLINE, EMBASE, and PsycINFO databases for all publications up to January 2018. To be included, studies utilizing any study design had to meet the following criteria: (1) a temporal association of tics with antipsychotic use where tics emerged during treatment or after discontinuation and (2) no diagnosis of Tourette syndrome before tic emergence. More stringent criteria were used for individuals under 18 years of age that included (1) no personal or family history of primary tic disorder and either (2) tics occurring during antipsychotic treatment improved significantly upon discontinuation or dose reduction or (3) tics emerged after discontinuation of at least 3 months of antipsychotic treatment. Data were extracted according to: age, sex, diagnosis, personal history of motor symptoms or family history of tics, antipsychotic type and dose, treatment duration, types of symptoms emerged, treatment strategies, and follow-up. A Fisher's exact test was used to compare the occurrence of symptoms between first- and second-generation antipsychotic users. RESULTS The search identified 1290 articles, of which 92 full-text articles were assessed leading to the inclusion of 50 articles. Most of the included articles were case reports or series, involving a total of 60 cases. Thirty cases were associated with treatment with first-generation antipsychotics, 27 with second-generation antipsychotics, and three with a combination of first- and second-generation antipsychotics. Antipsychotics were being used to treat schizophrenia in 60% of the cases and other indications included developmental, behavioral, and mood or anxiety disorders. Tics occurred during treatment (n = 44) or following treatment discontinuation (n = 16). The occurrence of vocal tics with or without motor tics was significantly higher in the first- vs. second-generation antipsychotic users (p < 0.0001). Significantly higher occurrences were also noted in the first- vs. second-generation antipsychotic users for specific types of vocal tics (i.e., barking and coprolalia) and other concurrent motor symptoms (i.e., tardive dyskinesia). In the cases identified, antipsychotic-associated tics were treated by (1) discontinuing the offending antipsychotic, reducing its dose, or switching to different antipsychotics for tics occurring during treatment, (2) reinitiating antipsychotic treatment for tics occurring following discontinuation, or (3) using non-antipsychotic agents. It should be noted that symptoms were not always fully reversible and recurred at times. CONCLUSION Tics can be a disturbing adverse effect of antipsychotics. Clinicians need to be particularly vigilant when initiating and modifying antipsychotic regimens.
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Affiliation(s)
- David D Kim
- Department of Anesthesiology, Pharmacology and Therapeutics, University of British Columbia, Vancouver, BC, Canada
| | - Alasdair M Barr
- Department of Anesthesiology, Pharmacology and Therapeutics, University of British Columbia, Vancouver, BC, Canada
| | - Yunsun Chung
- British Columbia Children's Hospital Research Institute, Vancouver, BC, Canada
| | - Jessica W Y Yuen
- Faculty of Medicine and Centre for Brain Health, University of British Columbia, Vancouver, BC, Canada
| | - Mahyar Etminan
- Department of Ophthalmology and Visual Sciences, University of British Columbia, Vancouver, BC, Canada
| | - Bruce C Carleton
- British Columbia Children's Hospital Research Institute, Vancouver, BC, Canada.,Division of Translational Therapeutics, Department of Pediatrics, University of British Columbia, Vancouver, BC, Canada.,Pharmaceutical Outcomes Programme, British Columbia Children's Hospital, Vancouver, BC, Canada
| | - Randall F White
- Department of Psychiatry, University of British Columbia, Room A3-111, 938 West 28th Avenue, Vancouver, BC, V5Z 4H4, Canada
| | - William G Honer
- Department of Psychiatry, University of British Columbia, Room A3-111, 938 West 28th Avenue, Vancouver, BC, V5Z 4H4, Canada
| | - Ric M Procyshyn
- Department of Psychiatry, University of British Columbia, Room A3-111, 938 West 28th Avenue, Vancouver, BC, V5Z 4H4, Canada.
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