Abstract
<strong>Background:</strong> Tourette syndrome (TS) has been described as peaking in adolescence with subsequent regression. We report patients who were diagnosed with TS during childhood who experienced a latent period (significant reduction in or absence of tics) followed by tic re-emergence in adulthood. <strong>Methods:</strong> We performed a retrospective chart review of outpatients over age 21 seen at the Yale neurology clinic between January 2012 and July 2016 who were diagnosed with childhood-onset tics, and who experienced a latent period of greater than 1 year followed by an exacerbation. <strong>Results:</strong> Sixteen patients were identified. The mean latent period was 16 years. Ten patients (62.5%) identified an exacerbation trigger, most commonly changes in substance use (five patients). Seven patients (43.8%) reported worsening of tics since childhood. Six patients (37.5%) had received pharmacological intervention for tics as children, and 15 patients (93.8%) as adults. Six of 15 patients (40.0%) had an effective response from those pharmacological intervention(s). <strong>Discussion:</strong> Our study demonstrates that the decline in symptoms as patients age may represent temporary improvement. The latent period lasted years in our patients, different from the more rapid waxing and waning in children. A change in substance use was an important trigger. Requests for pharmacological intervention were not necessarily correlated with worsening tic severity.
Highlights
Tourette syndrome (TS) is a life-long disorder but it is characterized by childhood onset, with the most severe symptoms occurring between 8 and 12 years, usually followed by a linear decline in severity.[1]
Fifteen of the 16 patients (93.8%) had comorbidities commonly associated with tic disorders, and many patients demonstrated more than one of these comorbidities
We retrospectively identified 16 patients who belong to a little-described subset of TS patients: those who are diagnosed with TS during childhood, experience a period of relief from or absence of symptoms before tic re-emergence in adulthood
Summary
Tourette syndrome (TS) is a life-long disorder but it is characterized by childhood onset, with the most severe symptoms occurring between 8 and 12 years, usually followed by a linear decline in severity.[1]. We report patients who were diagnosed with TS during childhood who experienced a latent period (significant reduction in or absence of tics) followed by tic re-emergence in adulthood. Methods: We performed a retrospective chart review of outpatients over age 21 seen at the Yale neurology clinic between January 2012 and July 2016 who were diagnosed with childhood-onset tics, and who experienced a latent period of greater than 1 year followed by an exacerbation. Ten patients (62.5%) identified an exacerbation trigger, most commonly changes in substance use (five patients). Six patients (37.5%) had received pharmacological intervention for tics as children, and 15 patients (93.8%) as adults. Requests for pharmacological intervention were not necessarily correlated with worsening tic severity
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