OCD symptoms in children with TS became more severe at a later age and were more likely to persist than tic symptoms
OCD symptoms in children with TS became more severe at a later age and were more likely to persist than tic symptoms.7 These comorbid behavioral conditions often interfere with learning and with academic and work performance. Jean Martin Charcot, coined the term em maladie des tics /em . He observed nine patients with symptoms of childhood-onset tics, waxing, and waning severity of symptoms and premonitory urge.1 Tics are defined as sudden, rapid, recurrent, nonrhythmic motor movements or vocalization, generally preceded by urge. Tics are frequently observed in the pediatric population and the frequency is higher (27%) in special education populations, compared with 19.7% in a general education sample.2 In a meta-analysis of 14 studies including 420,312 subjects, Tourettes syndrome (TS) was found to have a prevalence of 1%.3 The Tourette International Consortium reported the characteristics of TS patients in a large population where the age of symptom onset ranged from 2 to 21 years, with a mean of 6.4 years and male to female ratio of 4.4:1.4,5 The tics are most severe at 10C12 years old and eventually improves by adolescence in about 85% of the subjects.6,7 In another study, tics resolved completely in 50% of the patients while 40C45% of patients had improvement in tics by adulthood and only 5C10% of patients continued to have tics.8 Chronic tics and TS are more commonly seen in males than females. The male:female prevalence ranges from 2:1 to 10:1.9 The most widely accepted criteria are those formulated for TS by the fifth edition of the Diagnostic and Statistical Manual of Mental Disorders (DSM-V).10 Both multiple motors and one or more vocal tics are present at some time during the illness although not necessarily concurrently. The tics may wax or wane in frequency but have persisted for more than 1 year since the first tic onset. Onset is before age 18 years. The disturbance is not attributable to the physiologic effects of a substance (e.g., cocaine) or a general medical condition (e.g., Huntingtons disease, postviral encephalitis). The most common and mildest of the idiopathic tic disorders is the transient tic disorder of childhood. This can be differentiated from TS as it does not last for more than 1 year. The goal of this review is to provide Polaprezinc a summary of the clinical features of Tics and TS with pearls to distinguish them from other movement disorders. Also, this review summarizes the treatment modalities, including behavioral therapy, medical therapies, and deep Polaprezinc brain stimulation, and contains pearls and treatment modalities for TS. The search strategy included a PubMed search with MeSH words Tourettes syndrome or Tics combined with therapeutics or treatment or clinical features. Relevant articles were selected for this review, and bibliographies of research papers were also reviewed. References were selected from the review articles too. Clinical Features Proper history and phenomenology is the key for correct diagnosis as it can be challenging to differentiate between tics and other hyperkinetic disorders. Phenomenological classification of motor tics has been suggested by Jankovic and colleagues as follows: (1) clonic: tics involve only a single muscle or a group of muscles, causing a brief, jerking movement; (2) dystonic: tics are slower, causing a briefly sustained abnormal posture; and (3) tonic: tics reflect an isometric contraction, typically manifesting with a brief tension of abdominal or limb muscles.11 Examples include blinking, eye rolling, head nodding, shoulder shrugging, and abdominal tightening. Dystonic tics include oculogyric movements, sustained mouth opening, blepharospasm, and torticollis. Complex motor tics represent more intricate coordinated patterns of movement involving more than one muscle group. Bending, jumping, kicking, spitting, smelling, obscene gestures (copropraxia), and elaborate repertoires of movement are examples. Phonic tics are irrelevant sounds such as sniffing, coughing, throat clearing, clicks, humming, animal sounds, or whistling. Complex phonic tics consist of more involved utterances, including words, phrases, profanity, or racial slurs (coprolalia), repetition of others words (echolalia), or repetition of ones own words (palilalia). The differential diagnosis includes myoclonus, dystonia, athetosis, mannerisms, chorea, stereotypies, restless leg syndrome, or seizures. The.The search strategy included a PubMed search with MeSH words Tourettes syndrome or Tics combined with therapeutics or treatment or clinical features. as sudden, rapid, recurrent, nonrhythmic motor movements or vocalization, generally preceded by urge. Tics are frequently observed in the pediatric population and the frequency is higher (27%) in special education populations, compared with 19.7% in a general education sample.2 In a meta-analysis of 14 studies including 420,312 subjects, Tourettes syndrome (TS) was found to have a prevalence of 1%.3 The Tourette International Consortium reported the characteristics of TS patients Polaprezinc in a large population where the age of symptom onset ranged from 2 to 21 years, with a mean of 6.4 years and male to female ratio of 4.4:1.4,5 The tics are most severe at 10C12 years old and eventually improves by adolescence in about 85% of the subjects.6,7 In another study, tics resolved completely in 50% of the patients while 40C45% of patients had improvement in tics by adulthood and only 5C10% of patients continued to have tics.8 Chronic tics and TS are more commonly seen in males than females. The male:female prevalence Polaprezinc ranges from 2:1 to 10:1.9 The most widely accepted criteria are those formulated for TS by the fifth edition of the Diagnostic and Statistical Manual of Mental Disorders (DSM-V).10 Both multiple motors and one or more vocal tics are present at some time during the illness although not necessarily concurrently. The tics may wax or wane in frequency but have persisted for more than 1 year since Polaprezinc the first tic onset. Onset is before age 18 years. The disturbance is not attributable to the physiologic effects of a substance (e.g., cocaine) or a general medical condition (e.g., Huntingtons disease, postviral encephalitis). The most common and mildest of the idiopathic tic disorders is the transient tic disorder of childhood. This can be differentiated from TS as it does not last for more than 1 year. The goal of this review is to provide a summary of the clinical features of Tics and TS with pearls to distinguish them from other movement disorders. Also, this review summarizes the treatment modalities, including behavioral therapy, medical therapies, and deep brain stimulation, and contains pearls and treatment modalities for TS. The search strategy included a PubMed search with MeSH Pax1 words Tourettes syndrome or Tics combined with therapeutics or treatment or clinical features. Relevant articles were selected for this review, and bibliographies of research papers were also reviewed. References were selected from the review articles too. Clinical Features Proper history and phenomenology is the key for correct diagnosis as it can be challenging to differentiate between tics and other hyperkinetic disorders. Phenomenological classification of motor tics has been suggested by Jankovic and colleagues as follows: (1) clonic: tics involve only a single muscle or a group of muscles, causing a brief, jerking movement; (2) dystonic: tics are slower, causing a briefly sustained abnormal posture; and (3) tonic: tics reflect an isometric contraction, typically manifesting with a brief tension of abdominal or limb muscles.11 Examples include blinking, eye rolling, head nodding, shoulder shrugging, and abdominal tightening. Dystonic tics include oculogyric movements, sustained mouth opening, blepharospasm, and torticollis. Complex motor tics represent more intricate coordinated patterns of movement involving more than one muscle group. Bending, jumping, kicking, spitting, smelling, obscene gestures (copropraxia), and elaborate repertoires of movement are examples. Phonic tics are irrelevant sounds such as sniffing, coughing, throat clearing, clicks, humming, animal sounds, or whistling. Complex phonic tics consist of more involved utterances, including words, phrases, profanity, or racial slurs (coprolalia), repetition of others words (echolalia), or repetition of ones own words (palilalia). The differential diagnosis includes myoclonus, dystonia, athetosis, mannerisms, chorea, stereotypies, restless leg syndrome, or seizures. The sensory phenomenon of urge with improvement after the movement can also be seen in akathisia, stereotypy, and restless leg syndrome. All the hyperkinetic disorders, especially akathisia, and functional movements can be suppressed but less than tics.12 If the movements are multifocal or they migrate, consider myoclonus and chorea as well..