EpistemisMotor tics
Specialty: Neurology.
Why it occurs
- Tourette syndrome (neurodevelopmental disorder with multiple motor and phonic tics of childhood onset)
- Transient or persistent tic disorder of childhood
- Secondary tics induced by stimulant drugs (methylphenidate, amphetamines) or other toxins
- Post-neuroleptic tardive tics syndrome
- Post-infectious or autoimmune encephalitis (autoimmune neuropsychiatric disorders associated with streptococcus or PANDAS)
Initial workup
Integrated psychiatric and neurological clinical evaluation; video recording of tics for analysis of the stereotyped pattern and the presence of "premonitory urgency" (previous somatic sensation that is relieved when performing the tic); analysis with throat swab and immunoglobulins; Brain MRI if there is concomitant atypical neurological focality.
red flags
Acute or explosive onset of severe motor tics associated with severe obsessive-compulsive disorders, extreme emotional lability, swallowing difficulties or uncontrollable repetitive physical self-injury, suggesting a post-infectious autoimmune origin (basal encephalitis) or severe psychopathological decompensation.
Standard management
- Haloperidol — 0.5-3 mg/day, traditional dopamine antagonist
- Aripiprazole — 2-10 mg/day, dopamine partial agonist with better side effect profile
- Guanfacine or Clonidine — central alpha-2 adrenergic agonists, useful in tics associated with ADHD
- Tetrabenazine in severe refractory cases.
Educational guidance for study. It is NOT a prescription recommendation. The actual choice depends on the cause, the patient, and current guidelines.
- Area
- Neurology
- Listed causes
- 5
- Treatment options
- 4