Phenomenology of tics and natural history of tic disorders - ScienceDirect

Brain and Development

Volume 25, Supplement 1, 2003, Pages S24-S28

Brain and Development

https://doi.org/10.1016/S0387-7604(03)90004-0 Get rights and content

Abstract

Tic symptoms, the hallmark of Tourette's syndrome (TS), may simply be fragments of innate behavior. As such, the sensory urges that precede tics may illuminate some of the normal internal cues that are intimately involved in the assembly of behavioral sequences. The occurrence of tics in time appears to have fractal characteristics that may help to explain the waxing and waning course of tic disorders. Longitudinal studies are currently underway that should permit a close examination of the natural fluctuations in tic severity using valid and reliable clinician-rated scales of tic severity. The natural history of tics typically shows a marked decline during the course of adolescence. However, TS can also be associated with social, emotional, and academic difficulties in early adulthood. Comorbid attention deficit/hyperactivity disorder and obsessive-compulsive disorder are likely to influence the long-term adaptive outcomes of individuals with TS. Future progress may also be expected as endophenotypes, and possibly genetic markers, are identified that are associated with specific comorbid conditions and etiologically distinct forms of TS.

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Cited by (115)

Developmental stuttering, physical concomitants associated with stuttering, and Tourette syndrome: A scoping review
2023, Journal of Fluency Disorders
Developmental stuttering and Tourette syndrome (TS) are common neurodevelopmental disorders. Although disfluencies may co-occur in TS, their type and frequency do not always represent pure stuttering. Conversely, core symptoms of stuttering may be accompanied by physical concomitants (PCs) that can be confused for tics. This scoping review aimed to explore the similarities and differences between stuttering and tics in terms of epidemiology, comorbidities, phenomenology, evolution, physiopathology, and treatment. We also described the nature of PCs in stuttering and disfluencies in TS.
A literature search on Medline, Embase and PsycInfo was executed in March 2022. From 426 studies screened, 122 were included in the review (a majority being narrative reviews and case reports).
TS and stuttering have several epidemiological, phenomenological, comorbidity, and management similarities suggesting shared risk factors and physiopathology (involving the basal ganglia and their connections with speech and motor control cortical regions). PCs in stuttering commonly involve the face (eyelids, jaw/mouth/lip movements) and sometimes the head, trunk and limbs. PCs can be present from early stages of stuttering and vary over time and within individuals. The function of PCs is unknown. Some individuals with TS have a distinct disfluency pattern, composed of a majority of typical disfluencies (mostly between-word disfluencies), and a mix of cluttering-like behaviors, complex phonic tics (e.g. speech-blocking tics, echolalia, palilalia), and rarely, atypical disfluencies.
Future investigations are warranted to better understand the complex relationships between tics and stuttering and address the management of disfluencies in TS and PCs in stuttering.
Tic disorders and premonitory urges: validation of the Spanish-language version of the Premonitory Urge for Tics Scale in children and adolescents
2023, Neurologia
La mayoría de personas con tics persistentes refiere notar una sensación desagradable (impulso premonitorio) antes de sufrir un tic. En los últimos años, el interés hacia estos fenómenos sensoriales ha aumentado debido al importante papel que tienen en la terapia de conducta. Sin embargo, los instrumentos para evaluarlos aún son escasos. Entre ellos, la Escala para el Impulso Premonitorio al Tic (Premonitory Urge for Tics Scale, PUTS) es el más utilizado.
Examinamos las propiedades psicométricas y la estructura factorial de la versión española de la PUTS en una muestra de 72 niños y adolescentes con síndrome de Tourette o trastorno de tics persistentes. Analizamos los datos para el total de la muestra y por grupos de edad (niños hasta los 10 años y mayores de 10 años).
La PUTS obtuvo una buena consistencia interna y correlaciones moderadas entre ítems de la escala (excepto en el ítem uno). Se encontró una buena validez divergente, una adecuada fiabilidad test-retest y una estructura bifactorial (con una dimensión de fenómenos mentales relacionados con el trastorno obsesivo-compulsivo y otra sobre las cualidades y frecuencia de los impulsos premonitorios). Estos resultados se replicaron para ambos grupos de edad, excepto la validez divergente y la fiabilidad test-retest que fueron inferiores en el grupo de menor edad.
La versión española de la PUTS es una herramienta válida y fiable para evaluar los impulsos premonitorios en población infanto-juvenil, especialmente después de los 10 años.
Most people with persistent tics report an unpleasant sensation (premonitory urge) before the tic. In recent years, interest in these sensory phenomena has increased due to their important role in behavioural therapy. However, instruments for assessing these sensations remain scarce. Among the available instruments, the Premonitory Urge for Tics Scale (PUTS) is the most widely used.
We examined the psychometric properties and factor structure of the Spanish-language version of the PUTS in a sample of 72 children and adolescents with Tourette syndrome or persistent tic disorders. We analysed data from the total sample and by age group (children up to 10 years old and children/adolescents over 10).
The PUTS presented good internal consistency and moderate correlations between items on the scale (except for item one). Divergent validity was good, test-retest reliability was adequate, and a bifactorial structure was identified (one dimension related to mental phenomena reported in obsessive-compulsive disorder, and another related to the quality and frequency of premonitory urges). These results were replicated in both age groups, with lower divergent validity and test-retest reliability in the younger group.
The Spanish-language version of the PUTS is a valid, reliable tool for assessing premonitory urges in both children and adolescents, especially after the age of 10.
Other movement disorders, tics, chorea
2023, Medicine (Spain)
En esta actualización se revisan dos tipos de movimientos anormales hipercinéticos o discinéticos, movimientos excesivos que a menudo interfieren los actos motores voluntarios: los tics, representados en su dimensión máxima por el síndrome de Tourette y la corea, de etiología muy diversa y con la enfermedad de Huntington como paradigma.
This update will review two types of abnormal hyperkinetic or dyskinetic movements, excessive movements that often interfere with voluntary motor actions: tics, with its maximum expression in Tourette syndrome, and chorea, which has a highly varied etiology and Huntington's disease as a paradigm.
Long-term Outcomes of Behavior Therapy for Youth With Tourette Disorder
2022, Journal of the American Academy of Child and Adolescent Psychiatry
To determine the long-term durability of behavior therapy for tics among youth with Tourette disorder and persistent (chronic) motor or vocal tic disorders.
Of the 126 youth who participated in a randomized controlled trial of behavior therapy 11 years prior, 80 were recruited for this longitudinal follow-up. Consenting participants were interviewed in person or remotely (Web-based video) by trained evaluators to determine the course of tics, current tic severity, and tic-related impairment. Recruitment and data collection occurred between 2014 and 2019, with an average follow-up duration of 11.2 years.
Treatment responders to both conditions in the original trial achieved partial, but not full, tic remission. Tic severity also decreased significantly across the sample, with 40% reporting partial remission. Behavior therapy responders (n = 21) in the original trial were more likely (67%) to achieve remission at follow-up (Total Tic Score = 12.52, SD = 10.75) compared to psychoeducation/supportive therapy responders (n = 6, 0%) at follow-up (Total Tic Score = 20.67, SD = 6.92) on the Yale Global Tic Severity Scale. Tic-related impairment decreased across the sample, with no significant differences between treatment groups or responders.
Despite limitations of unmeasured variables and veracity of self-report at follow-up, this study supports guidelines recommending behavior therapy as the first-line intervention for tics. Further investigation of behavior therapy as an early preventive intervention also merits attention.
The Phenomenology of Tics and Tic-Like Behavior in TikTok
2022, Pediatric Neurology
Citation Excerpt :
Other atypical phenomenology noted in the videos includes a very high number of different tics, preponderance of complex behaviors or behaviors involving the trunk and extremities, tic-like behaviors consisting of long phrases, and tic-like behaviors consisting of throwing objects. In TS, simple tics are more common than complex tics,29-31 and tics affecting the eyes, face, and neck are more common than tics affecting the rest of the body.32 Although phonic tics can include phrases,31 these are generally short.
Pediatricians and pediatric subspecialists worldwide have reported a marked increase in functional (conversion) disorders with tic-like behaviors during the COVID-19 pandemic. These patients often report frequent viewing of Tourette syndrome (TS) TikTok videos, suggesting disease modeling. We aimed to evaluate tic phenomenology in videos posted on TikTok.
The 100 most-viewed videos under #tourettes in TikTok were randomly assigned to two of three primary reviewers (<2 years independent practice), all pediatric neurologists specializing in movement disorders, for extraction and classification of tic phenomenology. Initial disagreements were solved by consensus. If not resolved, one of five senior reviewers (>2 years independent pediatric movement disorder practice) served as a tiebreaker. In addition, two primary and one senior reviewer rated each video on a Likert scale from 1 = “All the tics are typical of TS” to 5 = “None of the tics are typical of TS”. Median scores and Spearman correlation between primary and senior reviewers were calculated.
Six videos without tic-like behaviors were excluded. Most videos depicted coprophenomena (coprolalia: 53.2%; copropraxia: 20.2%), often with unusual characteristics. Frequently, videos demonstrated atypical phenomenology such as very strong influence by the environment (motor: 54.3%; phonic: 54.3%), aggression (19.1%), throwing objects (22.3%), self-injurious behaviors (27.7%), and long phrases (>3 words; 45.7%). Most videos portrayed atypical, nontic behaviors (median [IQR] Likert ratings: 5 [4-5]). Primary vs. senior rater scores demonstrated moderate agreement (r = 0.46; P < 0.001).
TS symptom portrayals on highly viewed TikTok videos are predominantly not representative or typical of TS.
POINT: Is the Term Habit Cough an Inaccurate Use of a Term? Yes
2019, Chest

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