Diagnosis and assessment of tic disorders in children : A 10-year clinical studies in single center

Abstract

Background Tic disorders (TD) is a childhood onset neuropsychiatric disorder characterized by single or multiple motor tics or vocal/phonic tics.To date, the etiology and pathogenesis of TD is not definite.Tic symptoms and comorbidities seriously harm physical and mental health in children.Objective To summarize the clinical characteristics, diagnosis and assessment of tic disorders in children so as to provide theoretical evidence for comprehensive prevention and treatment of TD. Methods A total of 2002 TD cases were enrolled from 1999 to 2008 in the Children Health Care Department of the Affiliated Hospital of Medical College, Qingdao University.All cases were analyzed retrospectively. Results (1) There were 2002 cases children with TD in total. Male VS. female was 4.08∶1(1608∶394). The onset age were from 10 months to 21 years old. The peak onset age of TD ranged from 3 to 9 years old. (2) There were 471 cases of transient tic disorders(TTD). 90 patients had comorbidities. Attention deficit hyperactivity disorder(ADHD), obsessive-compulsive disorder(OCD), anxiety disorders accounted for 14.65%, 5.31%, 3.18%, respectively. 67.52%(318/471) of patients had simple motor tics as the initial symptom, and 57.96%(273/471) patients presented eye blinking. There were 689 cases of chronic tic disorders (CTD). 440 patients had comorbidities. ADHD, OCD, anxiety disorders accounted for 51.38%, 20.32%, 11.76%, respectively. 66.91%(461/689) of patients had simple motor tics as the initial symptom, 68.21%(470/689)presented eye blinking. There were 842 cases of Tourette syndrome (TS). 625 patients had comorbidities. ADHD, OCD, anxiety disorders were accounted for 57.96%, 25.06%, 23.75%, respectively. 81.47%(686/842) of patients had simple phonic tics as the initial symptom, 88.95%(749/842)presented throat clearing. (3) The misdiagnosed rate of three types were 58.82%(70/119), 55.07%(125/227), 34.76%(162/466) separately during previous diagnosis and treatment. 226(48.0%, 226/471), 211(30.6%, 211/689), 200(23.8%, 200/842)children had never further consultation with a doctor. (4) 98.20%(1966/2002)children were diagnosed as TD preliminarily. The symptoms severity degree of 0.99%(8/812)children were assessed during previous diagnosis and treatment, 37.68%(306/812) children were assessed with ADHD, No children were assessed with OCD; The symptoms severity degree of 10.54%(211/2002) children were assessed, 61.19%(1225/2002) children were assessed with ADHD, 33.57%(672/2002) children were assessed with OCD when they came to our hospital. Conclusions The onset age and the peak onset age of TD emerged more earlier than before. The prevalence in male was significantly higher than that in female. The cardinal symptoms were eye blinking and throat clearing. The misdiagnosed rate of TD was high. It was common in patients with comorbidities, ADHD, OCD, anxiety disorders were the main three types.Assessment of symptoms severity degree and comorbidity were often absent. These results showed that there were lots of problems in diagnosis and assessment of TD. Key words: Tic disorders; Diagnosis; Attention deficit disorder with hyperactivity; Obsessive-compulsive disorder