Tourette syndrome associated with attention deficit hyperactivity disorder: The impact of tics and psychopharmacological treatment options

Table 1 Types and description of tics

	Simple	Complex
Vocal or Phonic	Simple phonic/vocal tics: These are sudden meaningless noises or sounds	Complex phonic/vocal tics: These are sudden and more meaningful words, syllables or phrases
	Examples: Throat clearing, coughing, spitting, barking, hissing, sucking, clacking, gurgling, sniffing, grunting	Examples: Echolalia (repeating words or phrases spoken by others), palilalia (rapid repetition of one’s own words or phrases), and coprolalia (compulsive utterance of obscene words or phrases)
		Coprolalia is not pathognomonic of tourette syndrome. In fact less than 10% of tourette syndrome patients exhibit coprolalia. Hence, coprolalia is not required in diagnosing tourette syndrome
Motor	Simple motor tics: Rapid, meaningless contractions of one or a few muscles	Complex motor tics: Less common, typically more purposeful movements with a slower and longer nature. The movements appear more coordinated and may involve a cluster of movements
	Examples: Eye blinking, shoulder shrugging, head jerking, hand clapping, neck stretching, mouth movements, head, arm or leg jerks, and facial grimacing	Examples: Facial gestures, dystonic postures, throwing, arm thrusting, touching objects or people, stereotyped imitation of the movements (echopraxia) and obscene gestures (copropraxia)

Table 2 Definitions and classification of tic disorders

Classification of tic syndromes/tourette's disorder. Tourette Syndrome Classification Study Group. Tourette Syndrome Criteria: (TSCSG 1993)

A Both multiple motor and one or more vocal tics have been present at some time during the illness, although not necessarily concurrently

B The tics occur many times a day, nearly every day, or intermittently throughout a period of more than a year

C The anatomic location, number, frequency, complexity, type, severity of tics changes over time

D Onset before age 21

E Involuntary movements and noises cannot be explained by other medical conditions

F Motor and/or vocal tics must be witnessed by a reliable examiner directly at some point in the illness or be recorded by videotape or cinematography

Table 3 Common differential diagnoses of tics

Stroke

Dystonia

PANDAS

Encephalitis

Head trauma

Epileptic seizures

Sydenham’s chorea

Carbon monoxide poisoning

Functional movement disorders in children

Chromosomal disorders such as Down syndrome and Fragile X syndrome

Genetic conditions (such as Huntington’s disease, Wilson’s disease and Tuberous sclerosis)

Stereotypy (in developmental disorders such as Autism spectrum disorders and Stereotypic movement disorder)

Medication-induced tics (i.e., Neuroleptics, Stimulants, Antiepileptics, Lithium)

PANDAS: Pediatric Autoimmune Neuropsychiatric Disorders Associated with Streptococcal infections.