Functional Neurological Disorders Among Patients With Tremor

Incidence, clinical characteristics and related drugs analyzing of drug-induced movement disorders in 102914 inpatients: a retrospective real-world study

BACKGROUND

To investigate the incidence and clinical characteristics of drug-induced movement disorders(DIMDs)in a large group of hospitalized patients.

RESEARCH DESIGN AND METHODS

A retrospective study was conducted among hospitalized patients in 2022, utilizing the Adverse Drug Event Active Surveillance and Assessment System-II (ADE-ASAS-II). After the operation and manual selection, DIMDs cases were identified for analysis of incidence, associated drugs, and clinical characteristics.

RESULTS

Among 102,914 hospitalized patients, 504 cases were identified as DIMDs, with an incidence of 0.49%. There were more males than females.Most patients were over 65 years old.A total of 158 associated drugs across 15 classes were identified, with the top three classes being antibiotics(12.10%), antiepileptics(8.13%), and calcium channel blockers (7.14%).The top three drugs were sodium valproate(1.67%),meropenem(0.58%)and pregabalin (0.55%).The clinical manifestations were primarily shakiness, tremor and tic. Different manifestations are difficult to distinguish.It's necessary to make a thorough record and consult specialists.

CONCLUSION

For the first time, this study found that the incidence of DIMDs in hospitalized patients in general hospitals was 0.49%, occurs occasionally. Clinicians should pay close attention to the manifestations and identification of involuntary movements. Enhanced monitoring is recommended when using valproate, meropenem and pregabalin.

Neurodevelopmental Tics with Co-Morbid Functional Tic-like Behaviors: Diagnostic Challenges of a Complex Tourette Syndrome Phenotype

Background/Objectives: The co-morbidity between neurodevelopmental tics and functional tic-like behaviors (FTBs) in patients with Tourette syndrome (TS) is relatively under-investigated. The demographic and clinical characteristics of a large sample of patients with TS who presented with co-morbid FTBs (functional overlay) were assessed to raise awareness of this complex clinical presentation and to shed light on the differential diagnosis between the two conditions. Methods: We analyzed the clinical data of 63 patients (44 females, mean age 24 years, range 13-40) with pre-existing TS who (sub)acutely developed co-morbid FTBs (TS + FTBs) after the onset of the COVID-19 pandemic and compared them with 63 age- and gender-matched controls with TS (neurodevelopmental tics only). The diagnosis of co-morbid FTBs was validated by the European Society for the Study of Tourette Syndrome (ESSTS) criteria. Results: Complex vocal tics (p < 0.001), including coprolalia (p = 0.002), and self-injurious behaviors (p < 0.001), often as part of tic attacks (p < 0.001), were confirmed to be more commonly reported by the group of patients with TS + FTBs, who were also more likely to present with anxiety (p < 0.001) and other functional neurological symptoms (p < 0.001) compared to patients with TS. Conclusions: Patients with TS and co-morbid FTBs can pose significant diagnostic and treatment challenges. By systematically applying ESSTS criteria, we confirmed specific red flags for the diagnosis of functional overlay in patients with TS. The correct identification of this composite clinical phenotype plays a key role in preventing the misdiagnosis of treatment-resistant TS and implementing tailored treatment interventions.

Axial tics in Tourette syndrome and chronic tic disorders

BACKGROUND

Tics are the hallmark of Tourette syndrome (TS) and chronic tic disorders (CTD). Although typically involving the face, especially at onset, tics may involve any muscle under voluntary control, including axial muscles of the neck (causing head movements), shoulders and trunk (thorax and abdomen). We aimed to characterize these tics and provide a clinical frame for their associations and complications.

MATERIALS AND METHODS

We reviewed video recordings and clinical history of 196 patients with TS or CTD according to DSM-5.

RESULTS

Any axial tic was identified in 75% of patients. Tic distribution were head (n = 113, 57.6%), shoulder (n = 91, 46.4%), and trunk (n = 63, 32.2%). There were no differences in sex, age at onset or at evaluation between patients with and without axial tics. The most common axial tics by anatomical distribution were head turning, bilateral synchronous shoulder elevation and trunk jerks; however, tic phenomenology was quite variable. A greater severity of tics (P = 0.018) was associated with axial tics in the multivariate regression analysis. Head/neck tics associated with simple phonic tics (P = 0.002); whereas shoulder and trunk tics associated with complex motor tics (P < 0.05) in a bivariate analysis. Neck pain, breathing interference, sleep limitation and radiculopathy, secondary to axial tics were complications observed in a proportion of these cases.

CONCLUSIONS

Axial tics are commonly observed in patients with TS/CTD with variable phenomenology. They associate with greater tic severity, phonic tics and complex motor tics. They may result in neck pain, breathing interference, sleeping problems and cervical spine injuries.