open access

Vol 53, No 5 (2019)
Research paper
Published online: 2019-10-17
Submitted: 2019-04-19
Accepted: 2019-08-03
Get Citation

Dystonic tics in patients with Gilles de la Tourette syndrome

Natalia Szejko, Andrzej Jakubczyk, Anna Dunalska, Piotr Janik
DOI: 10.5603/PJNNS.a2019.0046
·
Pubmed: 31621889
·
Neurol Neurochir Pol 2019;53(5):335-340.

open access

Vol 53, No 5 (2019)
Research paper
Published online: 2019-10-17
Submitted: 2019-04-19
Accepted: 2019-08-03

Abstract

Clinical rationale for the study. Gilles de la Tourette syndrome (GTS) is a childhood onset disorder characterised by motor and vocal tics. Different types of motor tics may occur in GTS, including dystonic tics (DTs). Although DTs have been recognised as part of GTS symptomatology, little is known about their risk factors or about how often and at what age they appear in affected individuals.

Aim of the study. The aim of our study was to investigate lifetime prevalence and clinical correlations of DTs in a Polish cohort of GTS patients.

Material and methods. We performed a prospective, one-registration study in a cohort of 207 consecutive ambulatory patients (mean age: 16.5 ± 9.4 years, 131 children, 162 males) with GTS. Duration of GTS was 9.0 ± 8.0 years (range: 1–39 years). DTs were diagnosed during the interview. DTs were defined as slower and lasting longer than typical clonic tics, abnormal dystonia-like movements that led to a sustained, but not fixed, posture.

Results. DTs occurred at some point in the lifetime of 73.9% (n = 153) of patients. The prevalence of DTs in adults and children was almost the same (p = 0.963). Age at onset of DTs was 9.9 ± 5.2 years with the most frequent onset in children (7–11 years, 74.4%, n = 64), followed by adolescence (12–18 years; 17.4%, n = 15) and adulthood (≥ 18 years, 8.1%, n = 7). DTs occurred 3.7 ± 4.2 years after tic onset. On average, patients suffered from 1.8 ± 1.7 types of DTs. The most frequent manifestations of DTs were:
eyes (tightening resembling blepharospasm 84.3%, n = 129 and oculogyric crisis 45.8%, n = 70), trunk (dystonic postures 59.5%, n = 91), jaw (bruxism 34.6%, n = 53), neck (30.7%, n = 47), upper limb (26.1%, n = 40), and foot (20.9%, n = 32). Multivariate logistic regression analysis showed significant associations of DTs with the total number of simple, and the total number of complex, tics.

Conclusions and clinical implications. DTs are early and frequent symptoms of GTS. They tend to localise in the facial area. DTs occur more frequently in individuals with a higher number of tics and probably add to the global impairment caused by tics.

Abstract

Clinical rationale for the study. Gilles de la Tourette syndrome (GTS) is a childhood onset disorder characterised by motor and vocal tics. Different types of motor tics may occur in GTS, including dystonic tics (DTs). Although DTs have been recognised as part of GTS symptomatology, little is known about their risk factors or about how often and at what age they appear in affected individuals.

Aim of the study. The aim of our study was to investigate lifetime prevalence and clinical correlations of DTs in a Polish cohort of GTS patients.

Material and methods. We performed a prospective, one-registration study in a cohort of 207 consecutive ambulatory patients (mean age: 16.5 ± 9.4 years, 131 children, 162 males) with GTS. Duration of GTS was 9.0 ± 8.0 years (range: 1–39 years). DTs were diagnosed during the interview. DTs were defined as slower and lasting longer than typical clonic tics, abnormal dystonia-like movements that led to a sustained, but not fixed, posture.

Results. DTs occurred at some point in the lifetime of 73.9% (n = 153) of patients. The prevalence of DTs in adults and children was almost the same (p = 0.963). Age at onset of DTs was 9.9 ± 5.2 years with the most frequent onset in children (7–11 years, 74.4%, n = 64), followed by adolescence (12–18 years; 17.4%, n = 15) and adulthood (≥ 18 years, 8.1%, n = 7). DTs occurred 3.7 ± 4.2 years after tic onset. On average, patients suffered from 1.8 ± 1.7 types of DTs. The most frequent manifestations of DTs were:
eyes (tightening resembling blepharospasm 84.3%, n = 129 and oculogyric crisis 45.8%, n = 70), trunk (dystonic postures 59.5%, n = 91), jaw (bruxism 34.6%, n = 53), neck (30.7%, n = 47), upper limb (26.1%, n = 40), and foot (20.9%, n = 32). Multivariate logistic regression analysis showed significant associations of DTs with the total number of simple, and the total number of complex, tics.

Conclusions and clinical implications. DTs are early and frequent symptoms of GTS. They tend to localise in the facial area. DTs occur more frequently in individuals with a higher number of tics and probably add to the global impairment caused by tics.

Get Citation

Keywords

Gilles de la Tourette syndrome, dystonic tics, simple tics, complex tics, dystonia

About this article
Title

Dystonic tics in patients with Gilles de la Tourette syndrome

Journal

Neurologia i Neurochirurgia Polska

Issue

Vol 53, No 5 (2019)

Pages

335-340

Published online

2019-10-17

DOI

10.5603/PJNNS.a2019.0046

Pubmed

31621889

Bibliographic record

Neurol Neurochir Pol 2019;53(5):335-340.

Keywords

Gilles de la Tourette syndrome
dystonic tics
simple tics
complex tics
dystonia

Authors

Natalia Szejko
Andrzej Jakubczyk
Anna Dunalska
Piotr Janik

References (12)
  1. Cath DC, Hedderly T, Ludolph AG, et al. ESSTS Guidelines Group. European clinical guidelines for Tourette syndrome and other tic disorders. Part I: assessment. Eur Child Adolesc Psychiatry. 2011; 20(4): 155–171.
  2. Jankovic J, Stone L. Dystonic tics in patients with Tourette's syndrome. Mov Disord. 1991; 6(3): 248–252.
  3. Jankovic J. Botulinum toxin in the treatment of dystonic tics. Mov Disord. 1994; 9(3): 347–349.
  4. Erro R, Martino D, Ganos C, et al. Adult-Onset Primary Dystonic Tics: A Different Entity? Mov Disord Clin Pract. 2014; 1(1): 62–66.
  5. Stone LA, Jankovic J. The coexistence of tics and dystonia. Arch Neurol. 1991; 48(8): 862–865.
  6. Damásio J, Edwards MJ, Alonso-Canovas A, et al. The clinical syndrome of primary tic disorder associated with dystonia: a large clinical series and a review of the literature. Mov Disord. 2011; 26(4): 679–684.
  7. Leckman JF, Riddle MA, Hardin MT, et al. The Yale Global Tic Severity Scale: initial testing of a clinician-rated scale of tic severity. J Am Acad Child Adolesc Psychiatry. 1989; 28(4): 566–573.
  8. Stefanoff P, Wolańczyk T. [Validity and reliability of Polish adaptation of Yale Global Tic Severity Scale (YGTSS) in a study of Warsaw schoolchildren aged 12-15]. Przegl Epidemiol. 2005; 59(3): 753–762.
  9. Jankovic J. PHENOMENOLOGY AND CLASSIFICATION OF TICS. Neurologic Clinics. 1997; 15(2): 267–275.
  10. Ella B, Ghorayeb I, Burbaud P, et al. Bruxism in Movement Disorders: A Comprehensive Review. J Prosthodont. 2017; 26(7): 599–605.
  11. Correll CU, Schenk EM. Tardive dyskinesia and new antipsychotics. Curr Opin Psychiatry. 2008; 21(2): 151–156.
  12. Müller-Vahl KR, Krueger D. Does Tourette syndrome prevent tardive dyskinesia? Mov Disord. 2011; 26(13): 2442–2443.

Important: This website uses cookies. More >>

The cookies allow us to identify your computer and find out details about your last visit. They remembering whether you've visited the site before, so that you remain logged in - or to help us work out how many new website visitors we get each month. Most internet browsers accept cookies automatically, but you can change the settings of your browser to erase cookies or prevent automatic acceptance if you prefer.

By "Via Medica sp. z o.o." sp.k., ul. Świętokrzyska 73, 80–180 Gdańsk, Poland
tel.:+48 58 320 94 94, fax:+48 58 320 94 60, e-mail: viamedica@viamedica.pl