Functional tic-like presentations differ strikingly from Provisional Tic Disorder [version 2; peer review: 2 approved]
Background: Recent years have seen a dramatic increase in new “tic” cases in teens and young adults. These individuals often present with fulminant onset of symptoms not commonly seen in Tourette syndrome (TS) and are often diagnosed with Functional Neurological Symptom Disorder (FND-tic). However,...
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| Format: | Article |
| Language: | English |
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F1000 Research Ltd
2023-04-01
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| Series: | F1000Research |
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| Online Access: | https://f1000research.com/articles/11-1566/v2 |
| _version_ | 1797826578680381440 |
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| author | Kevin J. Black Emily C. Bihun Amanda L. Arbuckle Bradley L. Schlaggar |
| author_facet | Kevin J. Black Emily C. Bihun Amanda L. Arbuckle Bradley L. Schlaggar |
| author_sort | Kevin J. Black |
| collection | DOAJ |
| description | Background: Recent years have seen a dramatic increase in new “tic” cases in teens and young adults. These individuals often present with fulminant onset of symptoms not commonly seen in Tourette syndrome (TS) and are often diagnosed with Functional Neurological Symptom Disorder (FND-tic). However, some authors have questioned whether this illness truly differs from typical Provisional Tic Disorder (PTD) and TS. Previous studies have compared FND-tic, usually a few months after symptom onset, to patients with TS, usually years after symptom onset. We sought to test whether the presenting symptoms of FND-tic differ substantially from those in patients at a similar duration of symptoms who are later diagnosed with TS. Methods: This comparative study examines clinical features summarized from published reports of FND-tic with novel data from a longitudinal study of PTD. This study came from a referral center for TS and tic disorders and included 89 children with tics whose first tic occurred a median of 3.6 months earlier, nearly all of whom were diagnosed with a chronic tic disorder at follow-up. Specifically, we examine clinical features identified in a recent literature review as supporting a diagnosis of FND-tic, including symptom characteristics, course, severity and comorbidity. Results: Several clinical features dramatically distinguish the patients diagnosed with FND-tic from those diagnosed with typical PTD. For example, coprophenomena are reported at or shortly after symptom onset in over half of FND-tic patients, whereas even several months after onset, coprophenomena had occurred in only 1 of 89 children with PTD. Six clinical features each have a positive predictive value over 90% for FND-tic diagnosis if prior probability is 50%. Conclusions: These new data provide strong evidence supporting the diagnostic validity of FND-tic as distinct from TS. |
| first_indexed | 2024-04-09T12:34:38Z |
| format | Article |
| id | doaj.art-b7d291049cb344b0b631555fe9561aa5 |
| institution | Directory Open Access Journal |
| issn | 2046-1402 |
| language | English |
| last_indexed | 2024-04-09T12:34:38Z |
| publishDate | 2023-04-01 |
| publisher | F1000 Research Ltd |
| record_format | Article |
| series | F1000Research |
| spelling | doaj.art-b7d291049cb344b0b631555fe9561aa52023-05-16T00:00:02ZengF1000 Research LtdF1000Research2046-14022023-04-0111146566Functional tic-like presentations differ strikingly from Provisional Tic Disorder [version 2; peer review: 2 approved]Kevin J. Black0https://orcid.org/0000-0002-6921-9567Emily C. Bihun1Amanda L. Arbuckle2Bradley L. Schlaggar3Department of Psychiatry, Washington University in St. Louis, School of Medicine, St. Louis, Missouri, 63110, USADepartment of Psychiatry, Washington University in St. Louis, School of Medicine, St. Louis, Missouri, 63110, USADepartment of Psychiatry, Washington University in St. Louis, School of Medicine, St. Louis, Missouri, 63110, USADepartment of Pediatrics, Johns Hopkins Medicine, Baltimore, MD, 21287, USABackground: Recent years have seen a dramatic increase in new “tic” cases in teens and young adults. These individuals often present with fulminant onset of symptoms not commonly seen in Tourette syndrome (TS) and are often diagnosed with Functional Neurological Symptom Disorder (FND-tic). However, some authors have questioned whether this illness truly differs from typical Provisional Tic Disorder (PTD) and TS. Previous studies have compared FND-tic, usually a few months after symptom onset, to patients with TS, usually years after symptom onset. We sought to test whether the presenting symptoms of FND-tic differ substantially from those in patients at a similar duration of symptoms who are later diagnosed with TS. Methods: This comparative study examines clinical features summarized from published reports of FND-tic with novel data from a longitudinal study of PTD. This study came from a referral center for TS and tic disorders and included 89 children with tics whose first tic occurred a median of 3.6 months earlier, nearly all of whom were diagnosed with a chronic tic disorder at follow-up. Specifically, we examine clinical features identified in a recent literature review as supporting a diagnosis of FND-tic, including symptom characteristics, course, severity and comorbidity. Results: Several clinical features dramatically distinguish the patients diagnosed with FND-tic from those diagnosed with typical PTD. For example, coprophenomena are reported at or shortly after symptom onset in over half of FND-tic patients, whereas even several months after onset, coprophenomena had occurred in only 1 of 89 children with PTD. Six clinical features each have a positive predictive value over 90% for FND-tic diagnosis if prior probability is 50%. Conclusions: These new data provide strong evidence supporting the diagnostic validity of FND-tic as distinct from TS.https://f1000research.com/articles/11-1566/v2Tic Disorders/classification Provisional Tic Disorder Functional Neurological Symptom Disorder Conversion Disorder Diagnosis Differentialeng |
| spellingShingle | Kevin J. Black Emily C. Bihun Amanda L. Arbuckle Bradley L. Schlaggar Functional tic-like presentations differ strikingly from Provisional Tic Disorder [version 2; peer review: 2 approved] F1000Research Tic Disorders/classification Provisional Tic Disorder Functional Neurological Symptom Disorder Conversion Disorder Diagnosis Differential eng |
| title | Functional tic-like presentations differ strikingly from Provisional Tic Disorder [version 2; peer review: 2 approved] |
| title_full | Functional tic-like presentations differ strikingly from Provisional Tic Disorder [version 2; peer review: 2 approved] |
| title_fullStr | Functional tic-like presentations differ strikingly from Provisional Tic Disorder [version 2; peer review: 2 approved] |
| title_full_unstemmed | Functional tic-like presentations differ strikingly from Provisional Tic Disorder [version 2; peer review: 2 approved] |
| title_short | Functional tic-like presentations differ strikingly from Provisional Tic Disorder [version 2; peer review: 2 approved] |
| title_sort | functional tic like presentations differ strikingly from provisional tic disorder version 2 peer review 2 approved |
| topic | Tic Disorders/classification Provisional Tic Disorder Functional Neurological Symptom Disorder Conversion Disorder Diagnosis Differential eng |
| url | https://f1000research.com/articles/11-1566/v2 |
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