Bns 3 Exam - Tics And Tourettes

Front 1

Sudden, rapid, recurrent, nonrhythmic stereotyped motor movement or vocalization

Back 1

Tic

Front 2

1 to few muscles, fast, darting, meaningless

Back 2

Simple motor tic

Front 3

Slower, may appear purposeful movements (echopraxia, copropraxia)

Back 3

Complex motor tic:

Front 4

Meaningless sounds, noises

Back 4

Simple vocal tic:

Front 5

Linguistically meaningful words and phrases (coprolalia, echolalia, palilalia

Back 5

Complex vocal tic:

Front 6

_______ is the involuntary repetition or imitation of the observed movements of another.

Back 6

Echopraxia
Complex motor tic:

Front 7

________ is involuntarily performing obscene or forbidden gestures

Back 7

Copropraxia
Complex motor tic:

Front 8

The involuntary and repetitive use of obscene language, as a symptom of mental illness or organic brain disease.

Back 8

coprolalia
Complex vocal tic:

Front 9

_________an infant's repetition of sounds uttered by others

Back 9

echolalia
Complex vocal tic:

Front 10

_____a pathological condition in which a word is rapidly and involuntarily repeated

Back 10

palilalia
Complex vocal tic:

Front 11

Tourette’s Disorder criteria

Back 11

◦ Both multiple motor and one + vocal tics present at some time
◦ Time: Tics occur many times a day nearly every day or intermittently for at least one year; No tic free period greater than 3 months; onset must be less than 18 yrs old.
◦ Rule out substance induced, medical condition (Huntington’s, post viral encephalitis)
◦ Prevalence: 5-20/10,000
◦ More males than females
◦ Chronic waxing waning course
◦ Usually start in head, neck and progress

Front 12

Tourette’s Comorbidities:

Back 12

◦ 60-70% have ADHD (assoc. with higher levels of aggression)
◦ 50% have OCD (mostly obsessional)
◦ 50% have depression/anxiety
◦ 6.2% kids with autism have Tourette’s

Front 13

Tourette’s Genetics:

Back 13

◦ Autosomal Dominant with variable expression
◦ Penetration 100% in males, almost 50% in females
◦ 50% chance TD pt will pass genes on to child
◦ Concordance in mz twins is less than 100% so some environmental factor influence

Front 14

Differential Diagnosis of Tourette’s

Back 14

◦ Juvenile Huntington’s Disease
 10% of HD cases, rigidity, dystonia, chorea
Sydenham’s Chorea
◦ Myoclonic Disorder
◦ Subacute Sclerosing Panencephalitis (SSPE)
 Post measles, before age 2
 Asymptomatic for 6-15 yrs
 Gradual progressive sx including myoclonus
◦ Wilson’s Disease
◦ Medication Side Effects
 Stimulants, Bupropion
◦ Infection
Post viral encephalitis, HIV
◦ Toxins:
 Lead, Carbon Monoxide Poisoning

Front 15

What is PANDAS stands for?

Back 15

Pediatric Autoimmune Neuropscyhiatric Disorder Associated with Streptococcal infection

Front 16

with Tourettes diagnosis you need to rule out what other disorders?

Back 16

◦ PANDAS (followed by tics, hyperactivity, OCD)
◦ Chronic Vocal Tic Disorder
◦ Chronic Motor Tic Disorder
◦ Transient Tic Disorder (4 wks to 12 mos)

Front 17

Tourettes
Treatment:

Back 17

◦ First Line:
◦ Alpha 2 Agonists
◦ Clonidine: Less specific, more sedating
◦ Guanfacine: Central acting A2 Agonist recommended first line for Tourette’s.
◦ Watch for hypotension. Get baseline ECG and VS.
◦ Effective in 30-60% cases
◦ Second Line:
◦ Dopamine Blockers: Blocked D2 receptors in nigrostriatal pathway will reduce tics.
◦ Haldol, Risperdal, Olanzapine, Pimozide
◦ Pimozide is most specific but cardiotoxic, high risk of dystonia, dyskinesia

Front 18

Tourette’s Prognosis

Back 18

◦ Lifelong illness.
◦ Waxing, waning course.
◦ Severely affected are prone to serious emotional problems (depression, suicidality)

Front 19

Tourette’s ◦
Associated with:

Back 19

OCD - 50%
◦ ADHD - 60-70%
Depression/Anxiety