Tourette patients' misbelief of a tic rebound is due to overall difficulties in reliable tic rating

Abstract

ObjectiveWhile in clinical interviews the vast majority of patients with Tourette syndrome (TS) report about a tic rebound after voluntary tic suppression, in recent studies in children no paradoxical tic increase could be found. We hypothesized that in adult patients there is a tic rebound after tic suppression. MethodsWe investigated the tic severity, premonitory urges and influence of attention deficit hyperactivity disorder (ADHD) before, during and after tic suppression in 22 adult patients with TS using both an objective video tic rating and subjective patient ratings for tics and premonitory urges. ResultsAccording to the video rating, tic suppression resulted in a significant tic reduction, but no rebound. Patients also reported no tic rebound. They erroneously believed in an absolute tic reduction 20 and 30min after suppression, but paradoxically felt no relative tic change. Premonitory urges remained unchanged. There was no correlation between premonitory urges and tic severity. The potency for tic inhibition did not correlate with premonitory urges and tic severity. ADHD did not influence tic inhibition. ConclusionIn adults with TS, there is no tic rebound after voluntary tic suppression. Patients also reported no rebound, but erroneously felt a tic reduction in the later course of the study. This misjudgement as well as patients' often reported (mis-)belief of a tic rebound may be caused by overall difficulties in reliable tic rating. Premonitory urges remained unchanged during tic suppression. Tic suppression was not influenced by attention deficits. Premonitory urges are no prerequisite of tic suppression.