Summary
Definition
History and exam
Key diagnostic factors
- presença de fatores de risco
- tiques observados
- sensação premonitória
- capacidade de suprimir os tiques
- os sintomas podem melhorar em caso de distração
- restante do exame neurológico normal
Other diagnostic factors
- os sintomas se agravam com estresse, ansiedade, agitação ou transições
- intensidade variável ao longo do tempo
- sintomas de transtorno psiquiátrico comórbido
Risk factors
- início com <18 anos de idade
- sexo masculino
- história familiar de tiques
- história familiar de transtorno obsessivo-compulsivo (TOC), TDAH ou depressão
- tabagismo materno pré-natal
- história de TOC ou TDAH
- história de transtorno do espectro autista (TEA)
Diagnostic investigations
1st investigations to order
- diagnóstico clínico
Investigations to consider
- ressonância nuclear magnética (RNM) cranioencefálica com e sem contraste
- eletroencefalograma
- análise do líquido cefalorraquidiano (punção lombar)
Treatment algorithm
sintomas que não interferem nas atividades da vida diária
sintomas que interferem nas atividades da vida diária: não gestantes
tiques graves refratários a terapias comportamentais e farmacológicas
sintomas que interferem nas atividades da vida diária: gestantes
Contributors
Authors
Tamara Pringsheim, MD, FRCPC
Professor
University of Calgary
Department of Clinical Neurosciences, Psychiatry, Pediatrics, and Community Health Sciences
Calgary
Canada
Disclosures
TP has received research grants for Tourette's syndrome from Alberta Health and the Alberta Children's Hospital Research Institute. TP is an author of several references cited in this topic.
Acknowledgements
Professor Tamara Pringsheim would like to gratefully acknowledge Dr Tanya K. Murphy, Dr Fatima Masumova, Dr Cathy L. Budman, Dr Amber Stocco, Dr Migvis Monduy, and Dr Bobbi Hopkins, previous contributors to this topic.
Disclosures
FM, AS, MM, and BH declare that they have no competing interests. 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. 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.
Peer reviewers
Francis Filloux, MD
Chief
Division of Pediatric Neurology
University of Utah School of Medicine
Salt Lake City
UT
Disclosures
FF declares that he has no competing interests.
References
Key articles
Murphy TK, Lewin AB, Storch EA, et al. Practice parameter for the assessment and treatment of children and adolescents with tic disorders. J Am Acad Child Adolesc Psychiatry. 2013 Dec;52(12):1341-59.Full text Abstract
Pringsheim T, Okun MS, Müller-Vahl K, et al. Practice guideline recommendations summary: treatment of tics in people with Tourette syndrome and chronic tic disorders. Neurology. 2019 May 7;92(19):896-906.Full text Abstract
Pringsheim T, Holler-Managan Y, Okun MS, et al. Comprehensive systematic review summary: treatment of tics in people with Tourette syndrome and chronic tic disorders. Neurology. 2019 May 7;92(19):907-15.Full text Abstract
Kuo SH, Jimenez-Shahed J. Topiramate in treatment of Tourette syndrome. Clin Neuropharmacol. 2010 Jan-Feb;33(1):32-4. Abstract
Bloch MH, Panza KE, Landeros-Weisenberger A, et al. Meta-analysis: treatment of attention-deficit/hyperactivity disorder in children with comorbid tic disorders. J Am Acad Child Adolesc Psychiatry. 2009 Sep;48(9):884-93.Full text Abstract
Reference articles
A full list of sources referenced in this topic is available to users with access to all of BMJ Best Practice.
Differentials
- Comportamentos funcionais semelhantes a tiques
- Transtorno obsessivo-compulsivo (TOC)
- Estereotipias
More DifferentialsGuidelines
- Diagnosing tic disorders
- Treatment of tics in people with Tourette syndrome and chronic tic disorders
More GuidelinesPatient information
Transtorno obsessivo-compulsivo
TDAH: o que é?
More Patient information
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