Motor Tics Research Articles

Striatal Syntaxin 1A Is Associated with Development of Tourette Syndrome in an Iminodipropionitrile-Induced Animal Model.

Tourette syndrome (TS) is a neurodevelopmental movement disorder characterized by multiple motor and vocal tics. In this study, we used a TS rat model induced by 3,3′-iminodipropionitrile (IDPN) and aimed to investigate the expression change of Syntaxin 1A (STX1A). Rats in the control group received intraperitoneal injection of normal saline, and TS rats were injected with IDPN (150 mg/kg/day). After 7 days of treatment, the stereotypic behaviors were assessed. Next, rats were sacrificed; brains were removed for RNA extraction and Western blotting analysis and fixed in 4% paraformaldehyde for immunofluorescence analysis. After 7 days of IDPN administration, stereotypic behaviors were successfully induced. The IDPN group exhibited more counts in biting, putting forepaws around mouth, licking, head twitching, shaking claws, body raising, and episodic utterance. The striatal STX1A mRNA, protein, and STX1A expression in striatal dopaminergic neurons were investigated. As expected, the total STX1A mRNA and protein levels were decreased in the TS model rats. In the striatal dopaminergic neurons, the IDPN group showed a slightly decreased STX1A/TH double positive area, but no statistical significance was found. Additionally, we assessed the expression of some genes closely related to STX1A, such as SNAP25, SY, and gephyrin, and no differences were found between the two groups. Together, reduced STX1A expression is associated with IDPN-induced TS development. Our findings suggested that decreased striatal STX1A expression is associated with the development of TS in the IDPN-induced rat model.

Functional tics, the pandemic and social media

Functional tics form a part, albeit a small proportion, of the wider spectrum of functional neurological disorders (FND). In this review, we focus on the recent increase in presentations of functional tics since the COVID-19 pandemic. A functional tic disorder is often characterised by rapid onset of complex motor and vocal tics predominantly in adolescent females, distinct from Tourette’s syndrome which typically begins in younger boys. Rapid onset of severe tics merging into other types of functional neurological disorders, marked coprolalia, self-injury from tics and school absenteeism, are additional features of functional tics, however, the disorders can co-exist. There has been a lot of focus on social media as an explanation for the rise in cases, although the data suggest that this is just one of many potential factors, with the pandemic itself and its effect on teenage lives being the most likely culprit.

Enhancing neuroimaging genetics through meta-analysis for Tourette syndrome (ENIGMA-TS): A worldwide platform for collaboration.

Tourette syndrome (TS) is characterized by multiple motor and vocal tics, and high-comorbidity rates with other neuropsychiatric disorders. Obsessive compulsive disorder (OCD), attention deficit hyperactivity disorder (ADHD), autism spectrum disorders (ASDs), major depressive disorder (MDD), and anxiety disorders (AXDs) are among the most prevalent TS comorbidities. To date, studies on TS brain structure and function have been limited in size with efforts mostly fragmented. This leads to low-statistical power, discordant results due to differences in approaches, and hinders the ability to stratify patients according to clinical parameters and investigate comorbidity patterns. Here, we present the scientific premise, perspectives, and key goals that have motivated the establishment of the Enhancing Neuroimaging Genetics through Meta-Analysis for TS (ENIGMA-TS) working group. The ENIGMA-TS working group is an international collaborative effort bringing together a large network of investigators who aim to understand brain structure and function in TS and dissect the underlying neurobiology that leads to observed comorbidity patterns and clinical heterogeneity. Previously collected TS neuroimaging data will be analyzed jointly and integrated with TS genomic data, as well as equivalently large and already existing studies of highly comorbid OCD, ADHD, ASD, MDD, and AXD. Our work highlights the power of collaborative efforts and transdiagnostic approaches, and points to the existence of different TS subtypes. ENIGMA-TS will offer large-scale, high-powered studies that will lead to important insights toward understanding brain structure and function and genetic effects in TS and related disorders, and the identification of biomarkers that could help inform improved clinical practice.

Sertraline-Induced Tics: A Case Report and Narrative Review

This brief report describes the case of a 16-year-old girl who was commenced on sertraline for anxiety and depression, and subsequently developed severe and debilitating motor tics. Cessation of sertraline was associated with the resolution of tics; after this, paroxetine was trialled and well tolerated with good response of targeted symptoms and without re-emergence of tics. A narrative literature review yielded a retrospective observational study and eight single case reports on selective serotonin receptor inhibitor-induced motor tics (three in adolescents and five in adults). Tics are not commonly considered as a side-effect of SSRIs. This case report is novel is several aspects: the tics emergence was immediate whereas previous cases were delayed; the tics symptoms were measured and quantified by a validated scale; a dose-response relationship was observed; to our knowledge, our case was the first adolescent female reported; and finally, paroxetine was well-tolerated as a substitute, although it is unclear whether the observed tics-sparing effect is co-incidental, ideocratic or can be replicated.

“I'm in pain and I want help”: An online survey investigating the experiences of tic-related pain and use of pain management techniques in people with tics and tic disorders

ObjectivesTic disorders (TDs) are complex neurological conditions characterized by involuntary, persistent vocalizations and motor movements called tics. Tics involve brief muscle movements and can impair many aspects of daily functioning and quality of life in patients – and their physical nature can cause pain. Understanding individuals' experiences of tic-related pain and pain management could help explore this under-researched area and identify additional support needs for this population. The aim of this study was to investigate experiences of pain and use of pain management techniques in people with tic disorders.MethodsAn online survey consisting of multiple choice and open-ended questions exploring experiences of tic-related pain, help-seeking behavior for tic-related pain, and use of pain relief techniques for tic-related pain, was circulated online via international Tourette syndrome patient associations, and one online support group for Tourette syndrome. The online survey was open to adults (≥16 years) with self-reported tics. Open-ended questions were analyzed using thematic analysis.ResultsOne hundred eighty-one participants (16–71 years; 58.0% female) from 18 countries completed the online survey. Several aspects of tics were associated with pain, including the physical effort of motor tics (n = 177, 97.8%), repetitive tics (n = 141, 77.9%) and the consequences of tics (n = 131, 72.4%). Nearly two-thirds (n = 118, 64.6%) had sought professional help for tic-related pain. Distraction techniques (n = 126, 69.6%), taking pain relief medication (n = 125, 69.1%) and altering tics (n = 111, 61.3%) were the most commonly-reported methods used to relieve and cope with tic-related pain. Thematic analysis found an interrelated complex relationship between participants' tics, pain, and pain management techniques, reflected in four themes: the “tic-pain” cycle, the impact of pain, the importance of support, and the perceived successfulness of pain management techniques.ConclusionsTic-related pain was reported to have a significant physical and psychological impact which impacted aspects of daily living in people with tic disorders. The findings add to limited research suggesting tic-related pain is a dominant issue for individuals with tic disorders, potentially impacting upon their quality of life. Increased understanding of tic-related pain and its influence may be helpful in the long-term management of tic disorders, both in terms of clinical management and patients' self-management.

Mitochondrial DNA variant spectrum and the association with chronic tic disorders.

Tic disorders (TDs) are childhood onset neuropsychiatric disorders characterized by single or multiple sudden, rapid, recurrent, and motor tics and/or vocal tics. Several nuclear genes that are involved in mitochondrial functions suggest a potential role of mitochondria in TDs. To evaluate the association of mitochondrial DNA (mtDNA) variants with TDs, we screened the whole mitochondrial genomes in 493 TD patients and 109 age- and sex-matched healthy controls using next generation sequencing technology. A total of 1918 mtDNA variants including 1220 variants in patients only, 154 variants in controls only, and 544 variants shared by both cases and controls were identified. We found a higher number of overall mtDNA variants in TD patients (p= 0.00028). The variant density in MT-ATP6/8 and MT-CYB coding regions showed a significant difference between TD patients and controls (p= 0.0025 and p= 0.003, respectively). Furthermore, we observed a significant association of 15 common variants with TD based on an additive model, including m.14766C > T, m.14783 T > C, m.14905G > A, and m.15301G > A in MT-CYB; m.4769A > G, m.10398A > G, m.12705C > T, and m.12850A > G in MT-ND genes; m.7028C > T in MT-CO1; m.8701A > G in MT-ATP6; two variants with m.16223C > T, m.5580 T > C in noncoding regions; and three rRNA variants with m.1438A > G and m.750A > G in RNR1, and m.2352 T > C in RNR2. Our data provide evidence of mtDNA variants associated with TDs. The accumulation of the heteroplasmic levels may increase the risk of TDs. Replication studies with larger samples are necessary to understand the pathogenesis of TDs.

Magnetic resonance imaging demonstrates gyral abnormalities in Tourette syndrome.

Tourette syndrome (TS) is a neurological disorder characterized by involuntary and repetitive movements known as tics. A retrospective analysis of magnetic resonance imaging (MRI) scans from 39 children and adolescents with TS was performed and subsequently compared with MRI scans from 834 neurotypical controls. The purpose of this study was to identify any differences in the regions of motor circuitry in TS to further our understanding of their disturbances in motor control (i.e., motor tics). Measures of volume, cortical thickness, surface area, and surface curvature for specific motor regions were derived from each MRI scan. The results revealed increased surface curvature in the opercular part of the inferior frontal gyrus and the triangular part of the inferior frontal gyrus in the TS group compared with the neurotypical control group. These novel findings offer some of the first evidence for surface curvature differences in motor circuitry regions in TS, which may be associated with known motor and vocal tics.

A Pilot Study on Plasma and Urine Neurotransmitter Levels in Children with Tic Disorders.

Background: Tic disorders (TDs), including Tourette syndrome, are childhood-onset neuropsychiatric disorders characterized by motor and/or vocal tics that commonly affect children’s physical and mental health. The pathogenesis of TDs may be related to abnormal neurotransmitters in the cortico-striatal-thalamo-cortical circuitry, especially dopaminergic, glutamatergic, and serotonergic neurotransmitters. The purpose of this study was to preliminarily investigate the differences in the three types of neurotransmitters in plasma and urine between children with TD and healthy children. Methods: We collected 94 samples of plasma and 69 samples of urine from 3–12-year-old Chinese Han children with TD before treatment. The plasma and urine of the same number of healthy Chinese Han children, matched for age and sex, participating in a physical examination, were collected. Ultra-performance liquid chromatography-tandem mass spectrometry was used to detect the three types of neurotransmitters in the above samples. Results: The plasma levels of norepinephrine, glutamic acid, and γ-aminobutyric acid, and the urine levels of normetanephrine and 5-hydroxyindoleacetic acid were higher in the TD children than in healthy children. The area under the curve (AUC) values of the above neurotransmitters in plasma and urine analyzed by receiver operating characteristic curve analysis were all higher than 0.6, with significant differences. Among them, the combined AUC of dopamine, norepinephrine, normetanephrine, glutamic acid, and γ-aminobutyric acid in the 8–12-year-old subgroup was 0.930, and the sensitivity and specificity for TD were 0.821 and 0.974, respectively (p = 0.000). Conclusions: There are differences in plasma and urine neurotransmitters between TD children and healthy children, which lays a foundation for further research on the pathogenesis of TD.

Stress fracture of the clavicle in a case of frozen shoulder: Case report and review

Stress fractures are usually a rare incidence, but if it occurs, its more common in the lower limbs. Upper limb stress fractures are comparatively quite rare, wherein clavicular stress fractures are particularly uncommon. There have been a very few reported cases of clavicle stress fractures, and the cases have been reported in patients with nervous tics, post radical neck dissection and rarely due to sports. We report a case of clavicle stress fracture of a 55-year old female, who has been suffering from frozen shoulder.

Micro-RNAs from Plasma-Derived Small Extracellular Vesicles as Potential Biomarkers for Tic Disorders Diagnosis.

Tic disorders (TDs) are a series of childhood neuropsychiatric disorders characterized by involuntary motor and/or vocal tics and commonly comorbid with several other psychopathological and/or behavioral disorders (e.g., attention deficit hyperactivity disorder and obsessive–compulsive disorder), which indeed aggravate clinical symptoms and complicate diagnosis and treatment. Micro-RNAs (miRNAs) derived from small extracellular vesicles (sEVs) have been recognized as novel circulating biomarkers of disease. To identify specific miRNAs derived from plasma sEVs for TDs’ diagnosis and prognosis, we used official EV isolation and purification methods to characterize the plasma-derived EV miRNAs from children with different types of TDs. Nanoparticle tracking analysis, transmission electron microscopy, and immunoblot analysis of EV surface markers were applied to confirm the features and quality of sEVs. The RNA sequencing (RNA-seq) approach was adapted to identify novel circulating sEVs-derived miRNAs with altered expression levels in paired comparisons of TDs versus healthy controls (HCs), transient tic disorder (TTD) versus chronic motor or vocal tic disorder (CTD), and TTD versus Tourette Syndrome (TS). GO term and KEGG pathway were performed for functional analysis and the receiver operator curve analysis was followed to test the diagnosis efficacy of differentially expressed miRNAs (DEMs) derived from plasma sEVs among paired groups, namely, TDs versus HCs, TTD versus CTD, and TTD versus TS. As a result, 10 miRNAs (hsa-let-7a, hsa-let-7b, hsa-let-7c, hsa-let-7e, hsa-let-7f, hsa-miR-25-3p, hsa-miR-29a-3p, hsa-miR-30b-5p, hsa-miR-125b-5p, and hsa-miR-1469) have demonstrated a significantly different expression signature in the TDs group compared to HCs with excellent area under curve (AUC) values of 0.99, 0.973, 0.997, 1, 0.99, 0.997, 0.987, 0.993, 0.977, and 0.997, respectively, and the diagnostic efficacy of miRNAs was also estimated for discriminating TTD from CTD or TS. In our research, we finally obtained several potential sEVs-derived miRNA biomarkers to assess the diagnosis and prognosis of TDs.

Motor-like Tics are Mediated by CB2 Cannabinoid Receptor-dependent and Independent Mechanisms Associated with Age and Sex

Δ9-Tetrahydrocannabinol (Δ9-THC) inhibits tics in individuals with Tourette syndrome (TS). Δ9-THC has similar affinities for CB1/CB2 cannabinoid receptors. However, the effect of HU-308, a selective CB2 receptor agonist, on repetitive behaviors has not been investigated. The effects of 2,5-dimethoxy-4-iodoamphetamine (DOI)-induced motor-like tics and Δ9-THC were studied with gene analysis. The effects of HU-308 on head twitch response (HTR), ear scratch response (ESR), and grooming behavior were compared between wildtype and CB2 receptor knockout (CB2−/−) mice, and in the presence/absence of DOI or SR141716A, a CB1 receptor antagonist/inverse agonist. The frequency of DOI-induced repetitive behaviors was higher in CB2−/− than in wildtype mice. HU-308 increased DOI-induced ESR and grooming behavior in adult CB2−/− mice. In juveniles, HU-308 inhibited HTR and ESR in the presence of DOI and SR141716A. HU-308 and beta-caryophyllene significantly increased HTR. In the left prefrontal cortex, DOI increased transcript expression of the CB2 receptor and GPR55, but reduced fatty acid amide hydrolase (FAAH) and α/β-hydrolase domain-containing 6 (ABHD6) expression levels. CB2 receptors are required to reduce 5-HT2A/2C-induced tics in adults. HU-308 has an off-target effect which increases 5-HT2A/2C-induced motor-like tics in adult female mice. The increased HTR in juveniles induced by selective CB2 receptor agonists suggests that stimulation of the CB2 receptor may generate motor tics in children. Sex differences suggest that the CB2 receptor may contribute to the prevalence of TS in boys. The 5-HT2A/2C-induced reduction in endocannabinoid catabolic enzyme expression level may explain the increased endocannabinoids’ levels in patients with TS.

Use of aripiprazole in an obsessive compulsive disorder case with associated motor tics

IntroductionObsessive compulsive disorder (OCD) is a pathology represented by thoughts, images, impulses or feelings that generate great anxiety and discomfort, as well as the development of compulsive acts and rituals that cause great dysfunction.The comorbidity of different psychiatric disorders with OCD is known, such as impulse control disorder and tic disorder.ObjectivesThe objective of this study is to describe the clinical characteristics, comorbidities and the treatment used in a patient with an OCD diagnosis and motor tics.MethodsDescription of a clinical case of motor tics associated with OCD in an adult patient.ResultsA 29-year-old man begins mental health follow-up for presenting, as a result of a choking episode, obsessive thoughts with significant emotional and behavioral repercussions, to the point of restricting his diet and losing several kilos of weight. He also manifested checks and rituals in order to avoid possible choking.Treatment with sertraline and clonazepam was started, without evidence of improvement in symptoms. Months later, bucolingual and guttural tics, difficult to control by the patient and which caused bite lesions in the mouth and tongue, were added to the described clinic. Oral aripiprazole was associated to the treatment and then prolonged- release intramuscular administration was used, achieving improvement in obsessive symptoms and motor tics.ConclusionsThe usefulness of adjuvant treatment with atypical antipsychotics has been demonstrated in adults with OCD who present an insufficient response to an SSRI. Injectable prolonged-release antipsychotics can help improve long-term prognosis by ensuring adherence.DisclosureNo significant relationships.

Understanding the Phonological Strengths of Children with Tourette Syndrome

Tourette’s Syndrome (TS) is a neuropsychiatric disorder manifested in the form of motor and phonic tics (Thibault et al., 2007). Albeit the accumulating evidence shows how the condition affects people with TS, there appears to be a lack of studies that attempt to determine the advantages of children with TS, especially their phonological strengths. Informed by the innateness theory and biological determinism theory, this experimental research pursues to identify the phonological strengths of individuals with TS. Specifically, the analysis seeks to identify the phonemes uttered accurately and inaccurately by the three respondents. The study utilized Children’s Nonword Repetition (CNRep) as its instrument. The respondents repeated the nonwords from CNRep, and the accuracy of the utterances was analyzed. The results showed that the children with TS have phonological strengths and weaknesses, influenced by their motor and phonic tics. The respondents also displayed a fast response rate, which is believed to be the effect of the tics in the basal ganglia region. The findings reveal that they do not differ from typically-developing children as the study also proved that they also have innate mechanisms in phonological utterances.

Clinical phenotypes of autism spectrum disorders and epilepsy comorbidity

IntroductionASD with epileptic seizures (ES) and/or specific epileptic activity on EEG (EEG SEA) and repetitive movements and vocalizations (RMV) can be determined by different variants of genetic polymorphism or by different variants of gene expression, determined by different influences.ObjectivesTo study the features of the clinical phenotype of ASD in preschool and school-age children with ES, EEG SEA and RMV.Methods: The study group was divided 116 children aged 2-10 years with ASD into three subgroups: subgroup A - 23 children with a history of ES, subgroup B - 35 children with EEG SEA without ES, subgroup C - 19 children with ASD having EEG SEA, RMV (motor stereotypes, motor tics and/or vocal tics). The control group consisted of 39 children with ASD non a history of ES and EEG SEA.Results: Children with ASD, complicated by severe and frequent ES are charactered by impaired social reciprocity and communication against the background of regression / stagnation of speech and motor skills development (aOR: 2,7 [1,7-4,8]). Disoders of communication and repetitive behavior in ASD in children of different ages are represented by different monoqualitative syndrome (phenotypes). Movement stereotypes predominated in children with ASD without ES and without EEG SEA (aOR: [1,8-7,9]). In children with ASD and EEG SEA, motor stereotypes and repetitive behavior were equally common ([SD] 2.1 -1, P =0.81).Conclusions: Disorders of social reciprocity, communication, repetitive behavior are diagnostically significant for ASD complicated by ES, ASD with EEG SEA.DisclosureNo significant relationships.

Neurofibromatosis type 1 comorbid with attention deficit and hyperactivity disorder. Case report

IntroductionA 9-year-old girl under pediatric follow-up since the age of 4 years after diagnosis of neurofibromatosis type 1ObjectivesTo present a case of neurofibromatosis and ADHD comorbidity to raise awareness of the importance of screening for neurodevelopmental disorders.MethodsCase report and literature reviewResultsThe patient had an adequate control and follow-up of the disorder with periodic check-ups and magnetic resonance imaging during her follow-up. She was referred due to symptoms of inattention with failure to perform exams and impulsivity in interpersonal relationships, affecting her social functioning. In addition, the patient presented simple motor tics of eye contraction and shoulder elevation. The patient was diagnosed with attention deficit hyperactivity disorder together with tic disorder. She was treated with stimulant medication with worsening of tics and marked hyporexia. Therefore, medication with guanfacine was started up to 4 mg per day, adjusted by weight. With this dose there was a control of the tics, with improvement of the symptoms of inattention and impulsivity. In different spheres an improvement in their functionality was observed, with improvement in mood, self-esteem and academic performance.ConclusionsNeurofibromatosis type 1 is a rare monogenic disorder with a varied presentation (ophthalmologic, dermatologic and predisposition to tumor development). Patientshave been shown to present with symptoms of inattention and executive function impairment, along with other neurodevelopmental disorders such as autism spectrum disorders, learning disabilities or intellectual disability. The literature shows that up to 60% of them has ADHD criteria.DisclosureNo significant relationships.

Improved depressive symptoms in patients with refractory Gilles de la Tourette syndrome after deep brain stimulation of posteroventral globus pallidus interna.

ObjectiveDeep brain stimulation (DBS) has been used on drug‐resistant Gilles de la Tourette syndrome (GTS) for more than two decades until now, but the stimulating targets are still under exploration until now. In this study, the authors reported the efficacy of the bilateral posteroventral globus pallidus interna (GPi) DBS on tic severity and neuropsychiatry symptoms of seven individuals with GTS.MethodSeven patients with drug‐resistant GTS were enrolled in this study. The severity of these patients was evaluated with Yale Global Tics Severity Scale (YGTSS), Yale Brown Obsessive Compulsive Scale (YBOCS), Hamilton Depression Rating Scale (HAMD), Hamilton Anxiety Rating Scale (HAMA), and Global Assessment of Functioning Scale (GAF). Bilateral posteroventral GPi were selected as the permanent stimulating targets. Follow‐up period was at least 5 years after surgery in the enrolled patients.ResultsAfter surgery, one patient reported no improvement during the follow‐up period, and a device removal surgery was performed. The other six patients reported minor to significant improvement. The overall YGTSS, YBOCS, HAMA HAMD, and GAF scores of these patients were changed positively after surgery, but only the improvement of the motor tic and HAMD scores had a statistical difference. No surgical complication was reported.ConclusionsBilateral posteroventral GPi DBS could relieve the motor tics and depressive symptoms of the enrolled patients significantly, but the vocal tics and other psychiatric symptoms presented a progression without statistical difference during the follow‐up period. The results of this study suggested that bilateral posteroventral GPi are effective targets for the motor tics in GTS patients, especially with prominent depressive symptoms.

The Alternation of Gray Matter Morphological Topology in Drug-Naïve Tourette's Syndrome in Children.

Tourette syndrome (TS) is a neurodevelopment disorder characterized by motor and phonic tics. We investigated the topological alterations in pediatric TS using morphological topological analysis of brain structures. We obtained three-dimensional T1-weighted magnetic resonance imaging (MRI) sequences from 59 drug-naïve pediatric patients with TS and 87 healthy controls. We identified morphological topographical alterations in the brains of patients with TS compared to those of the healthy controls via GRETNA software. At the global level, patients with TS exhibited increased global efficiency (Eglob) (p = 0.012) and decreased normalized characteristic path length (λ) (p = 0.027), and characteristic path length (Lp) (p = 0.025) compared to healthy controls. At the nodal level, we detected significant changes in the nodal betweenness, nodal degree, and nodal efficiency in the cerebral cortex-striatum-thalamus-cortex circuit. These changes mainly involved the bilateral caudate nucleus, left thalamus, and gyri related to tics. Nodal betweenness, nodal degree, and nodal efficiency in the right superior parietal gyrus were negatively correlated with the motor tic scores of the Yale Global Tic Severity Scale (YGTSS) (r = −0.328, p = 0.011; r = −0.310, p = 0.017; and r = −0.291, and p = 0.025, respectively). In contrast, nodal betweenness, nodal degree, and nodal efficiency in the right posterior cingulate gyrus were positively correlated with the YGTSS phonic tic scores (r = 0.353, p = 0.006; r = 0.300, p = 0.021; r = 0.290, and p = 0.026, respectively). Nodal betweenness in the right supplementary motor area was positively correlated with the YGTSS phonic tic scores (r = 0.348, p = 0.007). The nodal degree in the right supplementary motor area was positively correlated with the YGTSS phonic tic scores (r = 0.259, p = 0.048). Diagnosis by age interactions did not display a significant effect on brain network properties at either the global or nodal level. Overall, our findings showed alterations in the gray matter morphological networks in drug-naïve children with TS. These findings enhance our understanding of the structural topology of the brain in patients with TS and provide useful clues for exploring imaging biomarkers of TS.

A hybrid sensor for motor tics recognition based on piezoelectric and triboelectric design and fabrication

With the gradual development of various artificial electronic skins and smart patches and other wearable electronic products, the collection of biomechanical energy to achieve self-powered sensing is critical to achieving the efficient function and sustainability of the system. In this work, a study of a novel hybrid sensor fabricated based on the piezoelectric and triboelectric design for motor tics recognition will be presented. A plant bionic and flexible hybrid self-powered sensor (PBHS) for motor tics recognition is reported. By combining bionic polydimethylsiloxane (PDMS) triboelectric nanogenerator and a layered stacked porous polyvinylidene fluoride-trifluoroethylene (PVDF-TrFE) nanofiber piezoelectric nanogenerator in mixing through near-field electrospinning (NFES) process on the flexible printed circuit board (FPCB) substrate, this enables the sensor which is a layer-by-layer stacked porous PVDF-TrFE nanofiber (LPPN) mainly composed of about 2500 piezoelectric polymers as a height of 2.2 mm thin wall to enhance energy harvesting characteristics. Compared with the original PVDF-TrFE nanogenerator, the voltage output performance is nearly reached to 5 V as a ~200% improvement. Furthermore, a self-powered tics recognition system has been developed through deep learning to provide doctors to observe the status of patients with motor tics of Tourette syndrome. By using the deep learning model of long short-term memory (LSTM) of a type of recurrent neural network (RNN), the overall sequences hybrid signal recognition rate for tic recognition has been achieved to 88.1%.

Prognosis of rapid onset functional tic-like behaviors: Prospective follow-up over 6 months.

Background and PurposeThe prognosis of rapid onset functional tic‐like behaviors (FTLBs) is unknown. This prospective cohort study describes the course and treatment of rapid onset FTLBs in adolescents (n = 20) and adults (n = 9) previously reported in two case series.MethodsYale Global Tic Severity Scale (YGTSS) scores were compared between first clinical presentation and 6‐month follow‐up assessment. All treatments used for FTLBs and any psychiatric comorbidities were recorded.ResultsIn adolescents with FTLBs, motor tics, vocal tics, total tics, impairment, and global scores on the YGTSS significantly improved at 6 months, with a mean decrease in the YGTSS global score of 31.9 points, 95% confidence interval (CI) 15.4, 48.4, p = .0005. In adults with FTLBs, only impairment and global scores significantly improved, with a mean decrease in the YGTSS global score of 19.6 points, 95% CI −3.2, 42.3, p = .04. Selective serotonin reuptake inhibitors (SSRIs) and cognitive behavioral therapy (CBT) for anxiety and depression were the most used treatment in both age groups.ConclusionsThis prospective study suggests that adolescents have a better prognosis than adults with FTLBs. Management of comorbidities with SSRIs and CBT seems effective.

Dystonic motor and phonic tics in Tourette syndrome.

Dystonic tics differ from clonic tics by their slower and more sustained nature. Dystonic tics are often present in patients with Tourette syndrome (TS) and other tic-disorders. However, their phenomenology and impact on overall impairment have not been extensively studied. We assessed clinical history and tic duration in video-recordings from patients with TS evaluated at our movement disorders clinic. Dystonic tics were defined as those lasting ≥ 1000ms (ms). Of the total of 201 patients with TS, there were 156 with video-recordings suitable for tic duration analysis, of their tics, 57 (36.5%) of whom had dystonic motor tics, including 9 (5.7%) with dystonic phonic tics. Dystonic motor tics had a duration range between 1033 and 15,000ms and dystonic phonic tics between 1132 and 17,766ms. Patients with dystonic tics were older 24.4 vs. 16.5years (P = 0.005) and had an older age at onset 12.9 vs. 7.2years (P < 0.001), than patients without dystonic tics. The bivariate analysis showed an association between the presence of dystonic tics, greater tic severity and wider body distribution. The multivariate regression analysis showed a statistical association with older age at evaluation (P = 0.001), greater tic severity on video-recordings (P = 0.001) and co-occurrence with complex motor tics (P = 0.020). The presence of dystonic tics increased the risk for being considered for deep brain stimulation therapy, odds ratio: 15.7 (P = 0.002). Dystonic tics, observed in about a third of patients with TS, are associated with increased severity of TS.