Abstract Details

Title Clinical Phenomenology of Functional Tics during the COVID-19 Pandemic

Topic Child Neurology and Developmental Neurology

Presentation(s) P1 - Poster Session 1 (9:00 AM-5:00 PM)

Poster/Presentation
Number 131

Objective

To describe the spectrum of clinical phenomenology observed in patients diagnosed with functional tics (FT).

Background Tremor, dystonia and gait disorders are the more common presenting phenomenology of functional movement disorders (FMD). FT are rarely reported. In pediatrics, estimates of FT vary from 0-17%^1,2. The rarity of FT may be attributed party due to the difficulty in distinguishing FT from organic tics. Many of the positive features utilized to diagnose FMDs are common amongst organic tics which poses a challenge for clinicians. With the dramatic increase in FT since the COVID19 pandemic^3-6, the aim of this case series is to describe the clinical phenomenology observed in pediatric FT.

Design/Methods

Retrospective data from 18 children diagnosed of FT from neurological evaluation during 2020-2021.

Results 18 children were included (1 male [6%,] 14 females [78%], 2 transgender female-to-males [11%], 1 gender fluid [6%]; mean age = 14.3 years±2.4). FT phenomenology at onset included abrupt onset (83%) with multiple tics (61% 1-5 tics, 33% 6-10 tics, 6% >10 tics) including simple motor (78%), complex motor (61%), complex vocal (44%) and simple vocal tics (33%). Complex motor tics included 50% self-abusive tics (89% hitting themselves), 11% abusive behavior towards others (100% hitting others), and 6% copropraxia. Complex vocal tics included 22% coprolalia, 22% echolalia, and 6% palilalia. Other common features included lack of premonitory sensation or urge (56%), no suppressibility (67%), complete distractibility (61%), lack of relief (61%), and specific triggers (50%). Many visited the emergency room for their FT (61%), had additional functional symptoms (56%), showed poor medication response if trialed (88%), and none had prior history of tics. Moderate-to-severe functional impairment was reported in 67% however only 28% reported interference with school or activities.

Conclusions Our case series in conjunction with prior case studies⁷ support there are some key distinguishing features of FT.

Authors/Disclosures
Jaclyn Martindale, DO, FAAN (Wake Forest Medical Center) PRESENTER	Dr. Martindale has received personal compensation in the range of $5,000-$9,999 for serving as an Editor, Associate Editor, or Editorial Advisory Board Member for Movement Disorder Society. The institution of Dr. Martindale has received research support from Tourette Association of America. The institution of Dr. Martindale has received research support from American Board of Neurology and Psychiatry.
Gregory Russell (Department of Biostatistics and Data Science)	No disclosure on file

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