1 Tic disorders

2 An involuntary, sudden rapid, recurrent, non-rhythmic, stereotyped motor involvement or vocalization Tics

3 Simple Motor Tics Eye blinking, grimacing, nose twitching, lip pouting, shoulder shrugs, arm and head jerks Complex Motor Tics Hopping, clapping, throwing, touching (self, others, objects), holding funny expressions, sticking out the tongue, kissing, pinching, tearing paper or books, echopraxia (repeating actions), copropraxia (obscene gestures) Tics Complex Motor Tics Hopping, clapping, throwing, touching (self, others, objects), holding funny expressions, sticking out the tongue, kissing, pinching, tearing paper or books, echopraxia (repeating actions), copropraxia (obscene gestures)

4 Simple Vocal Tics Whistling, coughing, sniffling,, screeching, barking, grunting, etc. Complex Vocal Tics Linguistically meaningful utterances: “I’ve got it.” “Oh boy.” “Now you’ve seen it.” Coprolalia, Echolalia, Palilalia Vocal Tics

5 Echolalia - involuntary repetition of someone else’s words Palilalia - involuntary repetition of one’s own words Coprolalia - involuntary utterance of curse words or other socially inappropriate phrases or sentences NOTE: Coprolalia is NOT necessary for a diagnosis of TS OTHER UNUSUAL TYPES OF VOCAL TICS

6 Stress Anxiety Excitement Fatigue iIlness Environmental Factors That Worsen TS

7 Tourette Syndrome Tourette Syndrome

8 Multiple motor and one or more vocal tics present at some time during the illness, although not necessarily simultaneously The occurrence of tics many times a day nearly every day or intermittently throughout a span of more than one year Periodic change in the number, frequency, type and location of tics and in the waxing and waning of their severity - Symptoms can disappear for weeks or months at a time,but nor than 3 months Onset before the age of 18 but most typically between the ages of 6 and 8 years DIAGNOSTIC CRITERIA

9 Epidemiology Prevalence 4-5/10000 M/F =3/1

10 Not everyone with tics has TS Differentiation from other tic disorders on the basis of duration of tics/age at onset  Transient Tic Disorder  Chronic Motor Tic Disorder  Chronic Vocal Tic Disorder D. DIFFERENTIAL DIAGNOSIS: OTHER TIC DISORDERS

11 E. ASSOCIATED DISORDERS TS is a Neurobiological spectrum disorder - most often accompanied by other neurological conditions (continued)

12 E. MOST COMMON ASSOCIATED DISORDERS An extremely large number of people with TS are also diagnosed with the following: Obsessive-Compulsive Disorder Attention Deficit Hyperactivity Disorder Learning Disabilities (continued)

13 E. LESS FREQUENTLY OCCURRING ASSOCIATED DISORDERS In addition, may exhibit other neurobiological symptoms, including: Executive dysfunction Depression Anxiety disorders Sleep disorders Fine-motor difficulties Aggressive and/or explosive behavior

14 The disorder is probably caused by abnormal metabolism of at least one brain chemical causing varying symptoms in different family members No medical test to prove or disprove the presence of TS The carrier genes have not yet been identified (continued)

15 Treatment Behavioral techniqes Pharmacotherapy antipsychotics clonidine guanfacin SSRIs