Which clinical history findings are characteristic of Tourette syndrome (TS) and other tic disorders?

Updated: May 30, 2019
  • Author: William C Robertson, Jr, MD; Chief Editor: Stephen L Nelson, Jr, MD, PhD, FAACPDM, FAAN, FAAP  more...
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Answer

Tics tend to fluctuate in severity, distribution, and character over intervals that are usually of weeks to years. A typical example is as follows: A boy starts blinking excessively when aged 5 years and develops a repetitive nonrhythmic palatal click several months later. By age 7 years, the blinking persists, while forceful nasal exhalations and shoulder shrugging have replaced the click. As a teenager, he has all the old tics present together with violent head shaking. In college, subtle head shaking and hardly visible abdominal tensing may be the only remaining tics, with exacerbations during examination week. [139]

Two case definitions for TS are accepted widely: the Diagnostic and Statistical Manual of Mental Disorders, 5th Edition (DSM-5) definition from the American Psychiatric Association, 2013, [1] which is widely used in the United States for clinical purposes (see the DSM-5 criteria for tic disorders below); and the Tourette Syndrome Study Group (TSSG) definition, 1993 [2] (see TSSG criteria for tic disorders below). Experts identify similar groups of patients by using either set of criteria.


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