The spectrum of functional tic‐like behaviours: Data from an international registry

• Published in: European journal of neurology Vol. 30; no. 2; pp. 334 - 343
• Main Authors: Martino, Davide, Hedderly, Tammy, Murphy, Tara, Müller‐Vahl, Kirsten R., Dale, Russell C., Gilbert, Donald L., Rizzo, Renata, Hartmann, Andreas, Nagy, Peter, Anheim, Mathieu, Owen, Tamsin, Malik, Osman, Duncan, Morvwen, Heyman, Isobel, Liang, Holan, McWilliams, Andrew, O'Dwyer, Shauna, Fremer, Carolin, Szejko, Natalia, Han, Velda X., Kozlowska, Kasia, Pringsheim, Tamara M.
• Format: Journal Article
• Language: English
• Published: England John Wiley & Sons, Inc 01.02.2023
• Subjects: Adolescent; Adolescents; Adults; Anxiety disorders; Attention Deficit Disorder with Hyperactivity; Attention deficit hyperactivity disorder; Autism; Autism Spectrum Disorder; Comorbidity; Data collection; Drug therapy; Female; functional neurological disorder; Humans; Life Sciences; Male; Mental depression; Mental disorders; Neurons and Cognition; Patients; Pharmacology; Phenomenology; Retrospective Studies; tic disorder; Tic Disorders - drug therapy; Tic Disorders - epidemiology; Tics; tic‐like behaviours; Tourette Syndrome - epidemiology; Very high frequencies; Young Adult; Young adults; tic disorder; functional neurological disorder; tic-like behaviours
• ISSN: 1351-5101; 1468-1331; 1468-1331
• DOI: 10.1111/ene.15611

Background and purpose Between 2019 and 2022, there was a marked rise in adolescents/young adults seeking urgent help for functional tic‐like behaviours (FTLBs). Given the global scale of this phenomenon, we aimed to pool cases from different institutions in an international registry to better characterize this spectrum and facilitate future longitudinal observation. Methods An international collaborative group from 10 tertiary referral centres for tic disorders collected retrospective data on FTLB patients who sought specialists' attention between the last quarter of 2019 and June 2022. An audit procedure was used for collection of data, which comprised demographics, course of presentation and duration, precipitating and predisposing factors, phenomenology, comorbidities, and pharmacological treatment outcome. Results During the study period, we collected data on 294 patients with FTLBs, 97% of whom were adolescents and young adults and 87% of whom were female. FTLBs were found to have a peak of severity within 1 month in 70% of patients, with spontaneous remissions in 20%, and a very high frequency of complex movements (85%) and vocalizations (81%). Less than one‐fifth of patients had pre‐existing primary tic disorder, 66% had comorbid anxiety disorders, 28% comorbid depressive disorders, 24% autism spectrum disorder and 23% attention deficit/hyperactivity disorder. Almost 60% explicitly reported exposure to tic‐related social media content. The vast majority of pharmacologically treated patients did not report benefit with tic‐suppressing medications. Conclusions Our data from the largest multicentre registry of FTLBs to date confirm substantial clinical differences from primary tic disorders. Social modelling was the most relevant contributing factor during the pandemic. Future longitudinal analyses from this database may help understand treatment approaches and responsiveness.