Transcript Document

Tic disorders
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Tics
An
involuntary, sudden
rapid,
recurrent,
non-rhythmic,
stereotyped
motor involvement or
vocalization
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Tics
Simple Motor Tics
Eye blinking, grimacing, nose
twitching, lip pouting, shoulder
shrugs, arm and head jerks
Complex Motor Tics
Hopping, clapping, throwing,
touching (self, others, objects),
holding funny expressions, sticking
out the tongue, kissing, pinching,
tearing paper or books, echopraxia
(repeating actions), copropraxia
(obscene gestures)
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Vocal Tics
Simple Vocal Tics
Whistling, coughing, sniffling,, screeching,
barking, grunting, etc.
Complex Vocal Tics
Linguistically meaningful utterances:
“I’ve got it.”
“Oh boy.”
“Now you’ve seen it.”
Coprolalia, Echolalia, Palilalia
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OTHER UNUSUAL TYPES OF
VOCAL TICS
 Echolalia - involuntary repetition of someone
else’s words
 Palilalia - involuntary repetition of one’s own
words
 Coprolalia - involuntary utterance of curse words
or other socially inappropriate phrases or
sentences
NOTE: Coprolalia is NOT necessary for a diagnosis of TS
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Environmental Factors
That Worsen TS
Stress
Anxiety
Excitement
Fatigue
iIlness
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Tourette Syndrome
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DIAGNOSTIC CRITERIA
 Multiple motor and one or more vocal tics present at
some time during the illness, although not
necessarily simultaneously
 The occurrence of tics many times a day nearly
every day or intermittently throughout a span of
more than one year
 Periodic change in the number, frequency, type and
location of tics and in the waxing and waning of their
severity - Symptoms can disappear for weeks or
months at a time,but nor than 3 months
 Onset before the age of 18 but most typically
between the ages of 6 and 8 years
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Epidemiology
• Prevalence 4-5/10000
• M/F =3/1
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D. DIFFERENTIAL DIAGNOSIS:
OTHER TIC DISORDERS
 Not everyone with tics has TS
 Differentiation from other tic
disorders on the basis of duration
of tics/age at onset
 Transient Tic Disorder
 Chronic Motor Tic Disorder
 Chronic Vocal Tic Disorder
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E. ASSOCIATED DISORDERS
TS is a Neurobiological spectrum
disorder - most often accompanied
by other neurological conditions
(continued)
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E. MOST COMMON ASSOCIATED
DISORDERS
An extremely large number of people
with TS are also diagnosed with the
following:
 Obsessive-Compulsive Disorder
 Attention Deficit Hyperactivity
Disorder
 Learning Disabilities
(continued)
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E. LESS FREQUENTLY OCCURRING
ASSOCIATED DISORDERS
In addition, may exhibit other neurobiological
symptoms, including:
 Executive dysfunction
 Depression
 Anxiety disorders
 Sleep disorders
 Fine-motor difficulties
 Aggressive and/or explosive behavior
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 The disorder is probably caused by abnormal
metabolism of at least one brain chemical
causing varying symptoms in different family
members
 No medical test to prove or disprove the
presence of TS
 The carrier genes have not yet been identified
(continued)
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Treatment
• Behavioral techniqes
• Pharmacotherapy
antipsychotics
clonidine
guanfacin
SSRIs
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