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Year : 2022  |  Volume : 10  |  Issue : 2  |  Page : 239-246

Neurodevelopmental versus functional tics: The state of the art

1 School of Medicine and Surgery, University of Milano-Bicocca, Milan, Italy; Department of Neuropsychiatry, BSMHFT and University of Birmingham, Birmingham; Sobell Department of Motor Neuroscience and Movement Disorders, Institute of Neurology and University College London, London; School of Life and Health Sciences, Aston Brain Centre, Aston University, Birmingham, United Kingdom
2 School of Medicine and Surgery, University of Milano-Bicocca, Milan, Italy

Correspondence Address:
Prof. Andrea E Cavanna
Department of Neuropsychiatry, National Centre for Mental Health, 25 Vincent Drive, Birmingham B15 2FG

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Source of Support: None, Conflict of Interest: None

DOI: 10.4103/amhs.amhs_246_22

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Tic disorders of neurodevelopmental origin are the most common hyperkinetic disorder in childhood. In cases where both multiple motor tics and at least one vocal tic are present, with a chronic course, a diagnosis of Tourette syndrome can be confirmed. Functional movement disorders are a common type of functional neurological disorder, which has previously been referred to as hysteria and conversion, among other diagnostic labels. Functional tics have long been considered a rarer phenotype of functional movement disorder, compared to functional tremor or functional dystonia. However, during the COVID-19 pandemic, there have been multiple reports worldwide of an unexpected increase in the number of adolescents and young adults presenting with acute-onset functional tics. The differential diagnosis between neurodevelopmental and functional tics can be challenging, but a few demographic and clinical features have proven useful in assisting clinicians. Neurodevelopmental tics present with the gradual onset of simple motor and vocal tics in a rostrocaudal evolution, starting in early childhood, more commonly in boys. Conversely, functional tics often have an abrupt and explosive presentation of severe symptoms, with a later age of onset and a female gender predominance. Moreover, it has been reported that a proportion of patients with functional tics developed their symptoms after being exposed to social media content of influencers displaying similar manifestations. The etiology of the recent “pandemic within the pandemic” is likely to be multifactorial, with increased exposure to social media possibly playing a role alongside the psychosocial impact caused by the COVID-19 pandemic.

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