An 8-year-old boy is evaluated in the clinic for unusual behaviors. His parents report that for the past 15 months, he has had intermittent episodes of rapid eye blinking, facial grimacing, and shoulder shrugging. Additionally, for the last 6 months, he has been frequently grunting and sniffing loudly. These actions occur many times a day and worsen when he is stressed about schoolwork. He is fully conscious during the episodes and says he feels a "build-up of tension" that is relieved only by performing the actions. Physical and neurologic examinations are otherwise unremarkable. Which of the following is the most likely diagnosis?
- Tourette syndromeAnswer
- BProvisional tic disorder
- CNormal developmental stereotypies
- DSydenham chorea
- EFocal aware seizures
Answer
Tourette syndrome
The correct answer is Tourette syndrome. The diagnosis of Tourette syndrome requires the presence of multiple motor tics (e.g., rapid eye blinking, facial grimacing, shoulder shrugging) and at least one vocal tic (e.g., grunting, sniffing) manifesting before age 18. Furthermore, the tics must be present for more than 1 year since the onset of the first tic. This patient's symptoms are preceded by a premonitory urge ("build-up of tension") that is temporarily relieved by performing the action, which is a classic feature of tics.
Here is a summary of pediatric tic disorders:
Here is a summary of pediatric tic disorders:
| Disorder | Characteristics | Duration |
|---|---|---|
| Tourette syndrome | Multiple motor AND vocal tic | year |
| Persistent (chronic) tic disorder | Motor OR vocal tics (but not both) | year |
| Provisional tic disorder | Motor and/or vocal tics | year |
Step-by-Step Solution
Key Concept
The diagnosis of Tourette syndrome requires the presence of both multiple motor tics and at least one vocal tic for a duration of greater than 1 year.