European Society for the Study of Tourette Syndrome 2022 criteria for clinical diagnosis of functional tic-like behaviours: International consensus from experts in tic disorders

Tamara Pringsheim¹, Christos Ganos², Christelle Nilles¹, Andrea E Cavanna^{3

4

5}, Donald L Gilbert^{6

7}, Erica Greenberg⁸, Andreas Hartmann⁹, Tammy Hedderly¹⁰, Isobel Heyman¹¹, Holan Liang¹¹, Irene Malaty¹², Osman Malik¹³, Nanette Mol Debes^{14

15}, Kirsten Muller Vahl¹⁶, Alexander Munchau¹⁷, Tara Murphy¹¹, Peter Nagy¹⁸, Tamsin Owen¹⁰, Renata Rizzo¹⁹, Liselotte Skov²⁰, Jeremy Stern²¹, Natalia Szejko²², Yulia Worbe²³, Davide Martino¹

Affiliations

¹ Department of Clinical Neurosciences, Psychiatry, Pediatrics, and Community Health Sciences, University of Calgary, Calgary, Alberta, Canada.
² Department of Neurology, Charité-Universitätsmedizin Berlin, Berlin, Germany.
³ Department of Neuropsychiatry, Birmingham and Solihull Mental Health National Health Service Foundation Trust and University of Birmingham, Birmingham, UK.
⁴ School of Life and Health Sciences, Aston University, Birmingham, UK.
⁵ School of Medicine and Surgery, University of Milan-Bicocca, Milan, Italy.
⁶ Division of Neurology, Cincinnati Children's Hospital Medical Center, Cincinnati, Ohio, USA.
⁷ Department of Pediatrics, University of Cincinnati College of Medicine, Cincinnati, Ohio, USA.
⁸ Department of Psychiatry, Massachusetts General Hospital, Boston, Massachusetts, USA.
⁹ National Reference Centre for Tourette Syndrome, Public Assistance Hospitals of Paris, Pitié-Salpêtrière Hospital Group, Paris, France.
¹⁰ Evelina London Childrens Hospital, Guys and St Thomas Trust and Kings College London, London, UK.
¹¹ UCL Great Ormond Street Institute of Child Health, London, UK.
¹² Department of Neurology, Fixel Institute for Neurological Diseases, University of Florida, Gainesville, Florida, USA.
¹³ Department of Children's Neuroscience, Evelina London Children's Hospital, Guys and St Thomas National Health Service Trust and South London and Maudsley National Health Service Trust, London, UK.
¹⁴ Copenhagen University Hospital-Herlev and Gentofte, Herlev, Denmark.
¹⁵ Department of Clinical Medicine, University of Copenhagen, Copenhagen, Denmark.
¹⁶ Department of Psychiatry, Social Psychiatry, and Psychotherapy, Hanover Medical School, Hanover, Germany.
¹⁷ Institute of Systems Motor Science, University of Lübeck, Lübeck, Germany.
¹⁸ Division of Neurodevelopmental Disorders, Bethesda Children's Hospital, Budapest, Hungary.
¹⁹ Child and Adolescent Neurology and Psychiatry, Department of Clinical and Experimental Medicine, Catania University, Catania, Italy.
²⁰ Department of Paediatrics, Copenhagen University Hospital-Herlev and Gentofte, Herlev, Denmark.
²¹ Department of Neurology, St George's, University of London, London, UK.
²² Department of Neurology, Department of Bioethics, Medical University of Warsaw, Warsaw, Poland.
²³ Department of Neurophysiology, Assistance Publique-Hopitaux de Paris.6-Pitié-Salpêtrière and Saint Antoine Hospitals, Sorbonne University, Paris, France.

PMID: 36587367
DOI: 10.1111/ene.15672

Review

European Society for the Study of Tourette Syndrome 2022 criteria for clinical diagnosis of functional tic-like behaviours: International consensus from experts in tic disorders

Tamara Pringsheim et al. Eur J Neurol. 2023 Apr.

. 2023 Apr;30(4):902-910.

doi: 10.1111/ene.15672. Epub 2023 Jan 13.

Authors

Affiliations

¹ Department of Clinical Neurosciences, Psychiatry, Pediatrics, and Community Health Sciences, University of Calgary, Calgary, Alberta, Canada.
² Department of Neurology, Charité-Universitätsmedizin Berlin, Berlin, Germany.
³ Department of Neuropsychiatry, Birmingham and Solihull Mental Health National Health Service Foundation Trust and University of Birmingham, Birmingham, UK.
⁴ School of Life and Health Sciences, Aston University, Birmingham, UK.
⁵ School of Medicine and Surgery, University of Milan-Bicocca, Milan, Italy.
⁶ Division of Neurology, Cincinnati Children's Hospital Medical Center, Cincinnati, Ohio, USA.
⁷ Department of Pediatrics, University of Cincinnati College of Medicine, Cincinnati, Ohio, USA.
⁸ Department of Psychiatry, Massachusetts General Hospital, Boston, Massachusetts, USA.
⁹ National Reference Centre for Tourette Syndrome, Public Assistance Hospitals of Paris, Pitié-Salpêtrière Hospital Group, Paris, France.
¹⁰ Evelina London Childrens Hospital, Guys and St Thomas Trust and Kings College London, London, UK.
¹¹ UCL Great Ormond Street Institute of Child Health, London, UK.
¹² Department of Neurology, Fixel Institute for Neurological Diseases, University of Florida, Gainesville, Florida, USA.
¹³ Department of Children's Neuroscience, Evelina London Children's Hospital, Guys and St Thomas National Health Service Trust and South London and Maudsley National Health Service Trust, London, UK.
¹⁴ Copenhagen University Hospital-Herlev and Gentofte, Herlev, Denmark.
¹⁵ Department of Clinical Medicine, University of Copenhagen, Copenhagen, Denmark.
¹⁶ Department of Psychiatry, Social Psychiatry, and Psychotherapy, Hanover Medical School, Hanover, Germany.
¹⁷ Institute of Systems Motor Science, University of Lübeck, Lübeck, Germany.
¹⁸ Division of Neurodevelopmental Disorders, Bethesda Children's Hospital, Budapest, Hungary.
¹⁹ Child and Adolescent Neurology and Psychiatry, Department of Clinical and Experimental Medicine, Catania University, Catania, Italy.
²⁰ Department of Paediatrics, Copenhagen University Hospital-Herlev and Gentofte, Herlev, Denmark.
²¹ Department of Neurology, St George's, University of London, London, UK.
²² Department of Neurology, Department of Bioethics, Medical University of Warsaw, Warsaw, Poland.
²³ Department of Neurophysiology, Assistance Publique-Hopitaux de Paris.6-Pitié-Salpêtrière and Saint Antoine Hospitals, Sorbonne University, Paris, France.

PMID: 36587367
DOI: 10.1111/ene.15672

Abstract

Background and purpose: In 2020, health professionals witnessed a dramatic increase in referrals of young people with rapid onset of severe tic-like behaviours. We assembled a working group to develop criteria for the clinical diagnosis of functional tic-like behaviours (FTLBs) to help neurologists, pediatricians, psychiatrists, and psychologists recognize and diagnose this condition.

Methods: We used a formal consensus development process, using a multiround, web-based Delphi survey. The survey was based on an in-person discussion at the European Society for the Study of Tourette Syndrome (ESSTS) meeting in Lausanne in June 2022. Members of an invited group with extensive clinical experience working with patients with Tourette syndrome and FTLBs discussed potential clinical criteria for diagnosis of FTLBs. An initial set of criteria were developed based on common clinical experiences and review of the literature on FTLBs and revised through iterative discussions, resulting in the survey items for voting.

Results: In total, 24 members of the working group were invited to participate in the Delphi process. We propose that there are three major criteria and two minor criteria to support the clinical diagnosis of FTLBs. A clinically definite diagnosis of FTLBs can be confirmed by the presence of all three major criteria. A clinically probable diagnosis of FTLBs can be confirmed by the presence of two major criteria and one minor criterion.

Conclusions: Distinguishing FTLBs from primary tics is important due to the distinct treatment paths required for these two conditions. A limitation of the ESSTS 2022 criteria is that they lack prospective testing of their sensitivity and specificity.

Keywords: Tourette syndrome; functional neurological disorder; tics.

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Comment in

Prospective follow-up study of youth and adults with onset of functional tic-like behaviours during the COVID-19 pandemic.
Nilles C, Szejko N, Martino D, Pringsheim T. Nilles C, et al. Eur J Neurol. 2024 Jan;31(1):e16051. doi: 10.1111/ene.16051. Epub 2023 Aug 29. Eur J Neurol. 2024. PMID: 37644767 Free PMC article.

References

REFERENCES

1. Pringsheim T, Ganos C, McGuire JF, et al. Rapid onset functional tic-like behaviors in young females during the COVID-19 pandemic. Mov Disord. 2021;36(12):2707-2713. doi:10.1002/mds.28778
1. Pringsheim T, Martino D. Rapid onset of functional tic-like behaviours in young adults during the COVID-19 pandemic. Eur J Neurol. 2021;28(11):3805-3808. doi:10.1111/ene.15034
1. Hull M, Parnes M. Tics and TikTok: functional tics spread through social media. Mov Disord Clin Pract. 2021;8(8):1248-1252. doi:10.1002/mdc3.13267
1. Han VX, Kozlowska K, Kothur K, et al. Rapid onset functional tic-like behaviours in children and adolescents during COVID-19: clinical features, assessment and biopsychosocial treatment approach. J Paediatr Child Health. 2022;58(7):1181-1187. doi:10.1111/jpc.15932
1. Heyman I, Liang H, Hedderly T. COVID-19 related increase in childhood tics and tic-like attacks. Arch Dis Child. 2021;106:420-421. doi:10.1136/archdischild-2021-321748

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European Society for the Study of Tourette Syndrome 2022 criteria for clinical diagnosis of functional tic-like behaviours: International consensus from experts in tic disorders

Affiliations

European Society for the Study of Tourette Syndrome 2022 criteria for clinical diagnosis of functional tic-like behaviours: International consensus from experts in tic disorders

Authors

Affiliations

Abstract

Comment in

References

REFERENCES

Publication types

MeSH terms

LinkOut - more resources

Full Text Sources

Medical