ECT for refractory secondary tourettism with dermatillomania following CO poisoning

Abstract

© 2015 Naguy et al; licensee Herbert Publications Ltd. This is an Open Access article distributed under the terms of Creative Commons Attribution License (http://creativecommons.org/licenses/by/3.0). This permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited. Correspondence ‘Secondary tourettism’ is euphemistically applied to refer to tics with underlying causations or associations mostly affecting basal ganglia, contrasted with the commonest cause of tics, that is, de la Tourette syndrome [1]. Causes are legion [2] as in Table 1. Treatment modalities for tics are protean [3] with differing qualities of evidence-base. Table 2 summarizes available options. Electro-convulsive therapy (ECT) for treatment-resistant tics is limited to case reports in literature. These cases were quite complex, Tourette syndrome with comorbid major depression disorder, obsessive-compulsive disorder, or, self-injurious behaviours. Tics as catatonic signs were also reported in two cases including autism [4]. More than 30% of patients with acute carbon monoxide (CO) may experience delayed onset of neuropsychiatric sequelae including, inter alia, motor, cognitive, and, affective aftermath [5]. Data in literature speak to the idea that Hyperbaric Oxygen Therapy (HBOT) could mitigate or halt the progression of such complications [6]. Here, we are reporting a case of CO poisoning, presented to us with difficult-to-treat secondary tics and dermatillomania that responded ultimately to ECT. This could open new treatment venues in such complicated clinical scenarios.