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Tourette's syndrome
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Tourette's syndrome

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BRAIN & NERVOUS SYSTEM

Movement Disorders

Additional information, publications and films can be obtained from:

Tourette Syndrome Association
42-40 Bell Boulevard
Bayside, New York 11361

Differential Diagnosis

Today the full-blown case of TS is unlikely to be confused with any other disorder. However, only a decade ago TS was frequently misdiagnosed as schizophrenia, obsessive-compulsive disorder, Sydenham's chorea, epilepsy, or nervous habits.

The differentiation of TS from other tic syndromes may be no more than semantic, especially since recent genetic evidence links TS with multiple tics. Transient tics of childhood are best defined in retrospect.

At times it may be difficult to distinguish children with extreme attention deficit hyperactivity disorder (ADHD) from TS. Many ADHD children, on close examination, have a few phonic or motor tics, grimace, or produce noises similar to those of TS. Since at least half of the TS patients also have attention deficits and hyperactivity as children, a physician may well be confused. However, the treating doctor should be aware of the potential dangers of treating a possible case of TS with stimulant medication.

On rare occasions the differentiation between TS and a seizure disorder may be problematic. The symptoms of TS sometimes occur in a rather sharply separated paroxysmal manner and may resemble automatisms. TS patients, however, retain a clear consciousness during such paroxysms. If the diagnosis is in doubt, an EEG may be useful.

We have seen TS in association with a number of developmental and other neurological disorders. It is possible that central nervous system injury from trauma or disease may cause a child to be vulnerable to the expression of the disorder, particularly if there is a genetic predisposition. Autistic and retarded children may display the entire gamut of TS symptoms, but whether an autistic or retarded individual requires the additional diagnosis of TS may remain an open question until there is a biological or other diagnostic test specifically for TS.

In older patients, conditions such as Wilson's disease, tardive dyskinesia, Meige's syndrome, chronic amphetamine abuse, and the stereotypic movements of schizophrenia must be considered in the differential diagnosis. The distinction can usually be made by taking a good history or by blood tests.

Since more physicians are now aware of TS, there is a growing danger of overdiagnosis or over-treatment. Prevailing diagnostic criteria would require that all children with suppressible multiple motor and phonic tics, however minimal, of at least one year, should be diagnosed as having TS. It is up to the clinician to consider the effect that the symptoms have on the patient's ability to function as well as the severity of associated symptoms before deciding to treat with medication.

Tourette's syndrome > 1 > 2 > 3 > 4

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