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Tics and functional tic-like movements: Can we tell them apart?

Ganos, C; Martino, D; Espay, AJ; Lang, AE; Bhatia, KP; Edwards, MJ (2019) Tics and functional tic-like movements: Can we tell them apart? Neurology, 93 (17). pp. 750-758. ISSN 1526-632X https://doi.org/10.1212/WNL.0000000000008372
SGUL Authors: Edwards, Mark John James

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Abstract

Within the broad spectrum of movement disorders, tics and functional tic-like movements belong to a particular clinical category. Both types of movements are within the range of normal movement kinematics and muscle synergies, but appear repetitive and without appropriate context embedment. Historically, there have been many attempts to separate the 2 types of movements, but because of their phenomenological overlap, clinical distinction may be prone to error, and misdiagnoses may often occur. Most importantly, the 2 types of movement may coexist. Here, we review the available literature on the 2 types of motor phenomena and demonstrate some of the difficulties in distinguishing tics from functional tic-like movements on clinical grounds. We also highlight similarities and differences in pathophysiologic characteristics, documenting the significance of action monitoring, attentional allocation, and behavioral reinforcement in both types of movements, as well as in their risk factors. We discuss the overlap of current behavioral treatments for tics and functional tic-like movements and emphasize implications of diagnostic mislabeling. Such implications include the need to tailor behavioral treatment approaches to individual phenomenological profiles and guiding decision making for severe patients requiring invasive interventions, such as deep brain stimulation. A deeper insight from clinicians with respect to persisting challenges in classifying and differentiating these motor phenomena could accelerate the development of reliable clinical and physiologic markers (i.e., next generation phenotyping) and a neurobiology-driven therapeutic approach for these motor phenomena.

Item Type: Article
Additional Information: Copyright © 2019 American Academy of Neurology.
Keywords: 1103 Clinical Sciences, 1109 Neurosciences, 1702 Cognitive Science, Neurology & Neurosurgery
SGUL Research Institute / Research Centre: Academic Structure > Molecular and Clinical Sciences Research Institute (MCS)
Journal or Publication Title: Neurology
ISSN: 1526-632X
Language: eng
Dates:
DateEvent
22 October 2019Published
24 September 2019Published Online
31 July 2019Accepted
Publisher License: Publisher's own licence
PubMed ID: 31551261
Go to PubMed abstract
URI: https://openaccess.sgul.ac.uk/id/eprint/111278
Publisher's version: https://doi.org/10.1212/WNL.0000000000008372

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