Abstract
Motor and vocal tics are common in childhood. The received wisdom among clinicians is that for most children the tics are temporary, disappearing within a few months. However, that common clinical teaching is based largely on biased and incomplete data. The present study was designed to prospectively assess outcome of children with what the current nomenclature calls Provisional Tic Disorder. We identified 43 children with recent onset tics (mean 3.3 months since tic onset) and re-examined 39 of them on the 12-month anniversary of their first tic. Tic symptoms improved on a group level at the 12-month follow-up, and only two children had more than minimal impairment due to tics. Remarkably, however, tics were present in all children at follow-up, although in several cases tics were apparent only when the child was observed remotely by video. Our results suggest that remission of Provisional Tic Disorder is the exception rather than the rule. We also identified several clinical features present at the first examination that predict one-year outcome; these include baseline tic severity, subsyndromal autism spectrum symptoms, and the presence of an anxiety disorder.
Highlights
Tics are sudden, rapid, recurrent, nonrhythmic movements or vocalizations such as eye blinking or throat clearing[1,2]
Previous cross-sectional studies that find an association between TS and a particular biological marker usually are unable to determine whether the association is causal, and if so whether the marker is a consequence or cause of the disease[9]
Abnormalities in TS that are present in Provisional Tic Disorder (PTD) are unlikely to reflect chronicity or adaptation
Summary
Rapid, recurrent, nonrhythmic movements or vocalizations such as eye blinking or throat clearing[1,2]. There is almost no information to determine which children will go on to need long-term treatment Studying this population offers the tantalizing possibility of secondary prevention of tic disorders (i.e., preventing progression to chronicity). While limited prospective data suggest that only a third of children with PTD show complete remission of tics over the 5–10 years[7], the epidemiology reviewed above suggests otherwise, and experts have opined that PTD usually remits within a few months[2,10,13,14,15,16,17,18,19,20,21]. We present the largest face-to-face, prospective study of clinical outcomes in PTD This project includes structural and functional MRI, a standardized tic suppression protocol, and various neuropsychological tests (www.NewTics.org). The study continues, but the protocol changed after these 43 were enrolled; this cohort is well suited for investigation of the clinical data
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