Kaplan + Sadock's Synopsis of Psychiatry, 11e

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31.8c Tourette’s Disorder

Table 31.8c-2 Differential Diagnosis of Tic Disorders

Disease or Syndrome

Predominant Type of Movement Choreic, athetoid, myoclonic

Age at Onset

Associated Features

Course

Hallervorden-Spatz Childhood- adolescence

May be associated with optic atrophy, club feet, retinitis pigmentosa, dysarthria, dementia, ataxia, emotional lability, spasticity, autosomal recessive inheritance inheritance commonly, primarily among Ashkenazi Jews; a more benign autosomal dominant form also occurs More common in females, usually associated with rheumatic fever (carditis elevated ASLO titers) Autosomal recessive

Progressive to death in 5 to 20 years

Dystonia

Childhood-

Variable course,

Dystonia

musculorum deformans

adolescence

often progressive but with rare remissions

Sydenham’s chorea Childhood, usually 5 to 15 yrs

Usually self-limited Choreiform

Huntington’s disease Usually 30 to 50 yrs, but childhood forms are known

Autosomal dominant

Progressive to death in 10 to 15 years after onset

Choreiform

inheritance, dementia, caudate atrophy on CT scan

Wilson’s disease

Usually 10 to 25 yrs Kayser-Fleischer rings, liver dysfunction, inborn error of copper metabolism; autosomal recessive inheritance

Progressive to

Wing-beating tremor, dystonia

(hepatolenticular degeneration)

death without chelating therapy

Hyperreflexias

Generally in childhood (dominant

Familial; may have generalized rigidity and autosomal inheritance

Nonprogressive

Excessive startle response; may have echolalia, coprolalia, and forced obedience

(including latah, myriachit, jumper disease of Maine)

inheritance)

Myoclonic disorders Any age

Numerous causes, some familial, usually no vocalizations

Variable,

Myoclonus

depending on cause Nonprogressive

Myoclonic dystonia 5 to 47 yrs

Nonfamilial, no vocalizations

Torsion dystonia with myoclonic jerks

Paroxysmal

Childhood

Attention, hyperactive,

Nonprogressive

Bursts of regular,

myoclonic dystonia with vocalization

and learning disorders; movements interfere with ongoing activity

repetitive clonic (less tonic) movements and vocalizations Orofacial dyskinesias, choreoathetosis, tics, vocalization

Tardive Tourette’s disorder syndromes

Variable (after

Reported to be precipitated by discontinuation or reduction of medication

May terminate

antipsychotic medication use)

after increase or decrease of dosage

Neuroacanthocytosis Third or fourth decade

Acanthocytosis, muscle wasting, parkinsonism, autosomal recessive inheritance

Variable

Orofacial dyskinesia

and limb chorea, tics, vocalization

Encephalitis lethargica

Variable

Shouting fits, bizarre behavior, psychosis, Parkinson’s disease Abnormal EEG; symmetrical theta and theta bursts frontocentrally Emotional lability, amnestic syndrome EEG: occasional asymmetrical theta bursts before movements, elevated ASLO titers

Variable

Simple and complex motor and vocal tics, coprolalia, echolalia, echopraxia, palilalia Simple motor and vocal tics

Gasoline inhalation Variable

Variable

Postangiographic complications

Variable

Variable

Simple motor and complex vocal tics, palilalia Simple motor and vocal tics, echopraxia

Postinfectious

Variable

Variable

Posttraumatic

Variable Variable

Asymmetrical tic distribution Variable

Complex motor tics

Carbon monoxide poisoning

Inappropriate sexual behavior

Variable

Simple and complex motor and vocal tics, coprolalia, echolalia, palilalia ( continued )