Summary
Definition
History and exam
Key diagnostic factors
- observed tics
- premonitory sensation
- ability to suppress tics
- symptoms may improve when distracted
- otherwise normal neurologic exam
Other diagnostic factors
- symptoms worse with stress, anxiety, or excitement
- variable severity over time
- symptoms of comorbid psychiatric disorder
Risk factors
- onset at age <18 years
- male sex
- family history of tics
- family history of obsessive-compulsive disorder (OCD), ADHD, or depression
- prenatal maternal smoking
- history of OCD or ADHD
- history of autism spectrum disorder (ASD)
Diagnostic investigations
Treatment algorithm
Contributors
Authors
JHMACH & USF Maurice A. and Thelma P. Rothman Chair of Developmental Pediatrics
Director, Rothman Center for Neuropsychiatry
Vice-Chair, University of South Florida Pediatrics
Professor, Departments of Pediatrics and Psychiatry
University of South Florida
Johns Hopkins All Children’s Hospital
St. Petersburg
FL
Disclosures
TKM has received research grants from Auspex Pharmaceuticals, the National Institute of Mental Health, Shire Pharmaceuticals, Pfizer Inc., F. Hoffman-La Roche Ltd., AstraZeneca Pharmaceuticals, Centers for Disease Control and Prevention, Massachusetts General Hospital, Sunovion Pharmaceuticals, Neurocrine Bioscience, Psyadon Pharmaceuticals, and PANDAS Network. She is on the advisory board for the International Obsessive Compulsive Foundation. She is also an author of several references cited in this topic.
Forensic Psychiatry Fellowship, PGY-6
Rutgers Robert Wood Johnson Medical School
New Brunswick
NJ
Disclosures
FM declares that she has no competing interests.
Director
National Tourette Centre of Excellence at Northwell Health
Director
Movement Disorders Program in Psychiatry
Professor
Hofstra Northwell School of Medicine
Northwell Health
Manhasset
NY
Disclosures
CLB has received research funding from Otsuka, Psyadon, Auspex, Teva, Neurocrine, and Synchroneuron Pharmaceuticals. She is a consultant for Bracket and a paid speaker for the Centers for Disease Control and Prevention (CDC) - National Tourette Syndrome Association Partnership. She is an author of several references cited in this topic.
Dr Tanya K. Murphy, Dr Fatima Masumova, and Dr Cathy L. Budman would like to gratefully acknowledge Dr Amber Stocco, Dr Migvis Monduy, and Dr Bobbi Hopkins, previous contributors to this topic. AS, MM, and BH declare that they have no competing interests.
Peer reviewers
Chief
Division of Pediatric Neurology
University of Utah School of Medicine
Salt Lake City
UT
Disclosures
FF declares that he has no competing interests.
Use of this content is subject to our disclaimer