2. TIC DISORDER TICS- RAPID AND REPETITIVE MUSCLE CONTRACTIONS RESULTING IN MOVEMENTS OR VOCALIZATIONS WHICH ARE INVOLUNTARY TYPES: SIMPLE MOTOR TICS- FUNCTIONALLY SIMILAR MUSCLE GROUPS EYE BLINKING, SHRUGGING OF SHOULDER, NECK JERKING SIMPLE VOCAL TIC- COUGHING,THROAT CLEARING, GRUNTING, SNIFFING COMPLEX MOTOR TICS- SMELLING OF OBJECTS, GROOMING BEHAVIOR, ECHOPRAXIA, COPROPRAXIA COMPLEX VOCAL TICS- REPEATING WORDS AND PHRASES OUT OF CONTEXT (COPROLALIA, ECHOLALIA) WAX AND WANE DECREASED BY SLEEP, RELAXATION OR ABSORPTION IN AN ACTIVITY
3. TOURETTE’S DISORDER DIAGNOSTIC CRITERIA A. BOTH MULTIPLE MOTOR AND ONE OR MORE VOCAL TICS HAVE BEEN PRESENT AT SOMETIME DURING THE ILLNESS, ALTHOUGH NOT NECESSARILY CONCURRENTLY B. THE TICS OCCUR MANY TIMES A DAY (USUALLY IN BOUTS) nearly everyday or intermittently throughout a period of more than one year AND DURING THIS PERIOD THERE WAS NEVER A TIC FREE PERIOD OF MORE THAN 3 CONSECUTIVE MONTHS C. THE ONSET IS before 18 years of age D. the disturbance is not due to direct physiological effects of a drug or a general medical condition
4. Tourette’s Disorder Lifetime prevalence 4 to 5 per 10,000 5 to 30 children per 10,000 onset of motor component by age 7 vocal tics by 11 years 3 males: 1 female Familial illness Association with ADHD and OCD ? Dopamine, endogenous opiods
5. Tourette’s Disorder ? Post streptococcal syndrome CLINICAL FEATURES Tics may occur as early as 2 years Initial tics in the face and neck progress downward Most frequent initial symptom eye blink tic, followed by head tic and facial grimace
6. Tourette’s Disorder PRODROME: IRRITABILITY, ATTENTION DIFFICULTIES, POOR FRUSTRATION TOLERANCE OBSESSIVE COMPULSIVE SYMTOMS OCCUR AFTER ONSET COPROLALIA IN 1/3 OF CASES NO SPECIFIC LABORATORY OR DIAGNOSTIC TEST TREATMENT - HALOPERIDOL
7. DIFFERENTIAL DIAGNOSIS 1.CHRONIC MOTOR OR VOCAL TIC DISORDER A. SINGLE OR MULTIPLE MOTOR OR VOCAL TICS BUT NOT BOTH, HAVE BEEN PRESENT AT SOMETIME DURING THE ILLNESS B. TICS OCCUR MANY TIMES A DAY NEARLY EVERYDAY OR INTERMITTENTLY THROUGHOUT A PERIOD OF MORE THAN O9NE YEAR AND DURING THIS PERIOD THERE WAS NEVER A TIC FREE PERIOD OF MORE THAN 3 CONSECUTIVE MONTHS C. THE ONSET IS BEFRORE 18 YEARS D. THE DISORDER IS NOT DUE TO THE PHYSIOLOGICAL EFFECTS OF A SUBSTANCE E. A CRITERIA HAVE NEVER BEEN MET FOR TOURETTE’S DISORDER
8. DIFFERENTIAL DIAGNOSIS TRANSIENT TIC DISORDER A. SINGLE OR MULTIPLE MOTOR AND OR VOCAL TICS B. THE TICS OCCUR MANY TIMES A DAY NEARLY EVERYDAY FOR AT LEAST 4 WEEKS BUT FOR NO LONGER THAN 12 CONSECUTIVE MONTHS C. ONSET BEFORE 18 YEARS D AND E (SIMILAR TO CHRONIC MOTOR TIC) DO NOT DEVELOP TO A MORE SERIOUS TIC DISORDER,MAY APPEAR DURING STRESS
