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      Provisional Tic Disorder: What to tell parents when their child first starts ticcing

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          Abstract

          The child with recent onset of tics is a common patient in a pediatrics or child neurology practice. If the child’s first tic was less than a year in the past, the diagnosis is usually Provisional Tic Disorder (PTD). Published reviews by experts reveal substantial consensus on prognosis in this situation: the tics will almost always disappear in a few months, having remained mild while they lasted. Surprisingly, however, the sparse existing data may not support these opinions.

          PTD may have just as much importance for science as for clinical care. It provides an opportunity to prospectively observe the spontaneous remission of tics. Such prospective studies may aid identification of genes or biomarkers specifically associated with remission rather than onset of tics. A better understanding of tic remission may also suggest novel treatment strategies for Tourette syndrome, or may lead to secondary prevention of tic disorders.

          This review summarizes the limited existing data on the epidemiology, phenomenology, and outcome of PTD, highlights areas in which prospective study is sorely needed, and proposes that tic disorders may completely remit much less often than is generally believed.

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          Most cited references104

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          Definition and classification of hyperkinetic movements in childhood.

          Hyperkinetic movements are unwanted or excess movements that are frequently seen in children with neurologic disorders. They are an important clinical finding with significant implications for diagnosis and treatment. However, the lack of agreement on standard terminology and definitions interferes with clinical treatment and research. We describe definitions of dystonia, chorea, athetosis, myoclonus, tremor, tics, and stereotypies that arose from a consensus meeting in June 2008 of specialists from different clinical and basic science fields. Dystonia is a movement disorder in which involuntary sustained or intermittent muscle contractions cause twisting and repetitive movements, abnormal postures, or both. Chorea is an ongoing random-appearing sequence of one or more discrete involuntary movements or movement fragments. Athetosis is a slow, continuous, involuntary writhing movement that prevents maintenance of a stable posture. Myoclonus is a sequence of repeated, often nonrhythmic, brief shock-like jerks due to sudden involuntary contraction or relaxation of one or more muscles. Tremor is a rhythmic back-and-forth or oscillating involuntary movement about a joint axis. Tics are repeated, individually recognizable, intermittent movements or movement fragments that are almost always briefly suppressible and are usually associated with awareness of an urge to perform the movement. Stereotypies are repetitive, simple movements that can be voluntarily suppressed. We provide recommended techniques for clinical examination and suggestions for differentiating between the different types of hyperkinetic movements, noting that there may be overlap between conditions. These definitions and the diagnostic recommendations are intended to be reliable and useful for clinical practice, communication between clinicians and researchers, and for the design of quantitative tests that will guide and assess the outcome of future clinical trials.
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            The international prevalence, epidemiology, and clinical phenomenology of Tourette syndrome: a cross-cultural perspective.

            The overall international prevalence of Tourette syndrome (TS) is 1% in the majority of cultures of the world. Both TS and tics are certainly more obvious and may be more common in younger people. Moreover, TS is seen less frequently in some cultures. However, in all cultures where it has been reported, the phenomenology is similar, highlighting the biological underpinnings of the disorder. This article reviews the international prevalence, epidemiology, and clinical phenomenology of TS, from a cross-cultural perspective.
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              The Great Smoky Mountains Study of Youth. Goals, design, methods, and the prevalence of DSM-III-R disorders.

              The Great Smoky Mountains Study of youth focuses on the relationship between the development of psychiatric disorder and the need for and use of mental health services. A multistage, overlapping cohorts design was used, in which 4500 of the 11758 children aged 9, 11, and 13 years in an 11-county area of the southeastern United States were randomly selected for screening for psychiatric symptoms. Children who scored in the top 25% on the screening questionnaire, together with a 1 in 10 random sample of the rest, were recruited for 4 waves of intensive, annual interviews (n = 1015 at wave 1). In a parallel study, all American Indian children aged 9, 11, and 13 years were recruited (N = 323 at wave 1). The 3-month prevalence (+/-SE) of any DSM-III-R axis I disorder in the main sample, weighted to reflect population prevalence rates, was 20.3% +/- 1.7%. The most common diagnoses were anxiety disorders (5.7% +/- 1.0%), enuresis (5.1% +/- 1.0%), tic disorders (4.2% +/- 0.9%), conduct disorder (3.3% +/- 0.6%), oppositional defiant disorder (2.7% +/- 0.4%), and hyperactivity (1.9% +/- 0.4%). The prevalence of psychiatric disorder in this rural sample was similar to rates reported in other recent studies. Poverty was the strongest demographic correlate of diagnosis, in both urban and rural children.
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                Author and article information

                Journal
                F1000Res
                F1000Res
                F1000Research
                F1000Research
                F1000Research (London, UK )
                2046-1402
                18 April 2016
                2016
                : 5
                : 696
                Affiliations
                [1 ]Departments of Psychiatry, Washington University School of Medicine, St. Louis, USA
                [2 ]Departments of Neurology, Washington University School of Medicine, St. Louis, USA
                [3 ]Departments of Radiology, Washington University School of Medicine, St. Louis, USA
                [4 ]Departments of Neuroscience, Washington University School of Medicine, St. Louis, USA
                [5 ]Brigham Young University, Utah, USA
                [6 ]Departments of Pediatrics, Washington University School of Medicine, St. Louis, USA
                [1 ]Department of Neurology, St. George's Hospital and Medical School, London, UK
                [1 ]School of Life and Health Sciences, Aston Brain Centre, Wellcome Trust Laboratory for Magnetoencephalographic (MEG) studies, Aston University, Birmingham, UK
                Department of Psychiatry, Washington University in St Louis, USA
                [1 ]Department of Neurology, Assistance Publique- Hopitaux de Paris, Paris, France
                Department of Psychiatry, Washington University in St Louis, USA
                Author notes

                KJB conceived the study and wrote the first draft. KJB and ERB found and tabulated data from primary sources. DJG gave feedback on early drafts. All authors were involved in the revision of the draft manuscript and have agreed to the final content.

                Competing interests: No competing interests were disclosed.

                Competing interests: No competing interests were disclosed.

                Competing interests: No competing interests were disclosed.

                Competing interests: No competing interests were disclosed.

                Competing interests: No competing interests were disclosed.

                Competing interests: No competing interests were disclosed.

                Article
                10.12688/f1000research.8428.1
                4850871
                27158458
                c8e547bc-4e9a-4132-8761-9711cf93be32
                Copyright: © 2016 Black KJ et al.

                This is an open access article distributed under the terms of the Creative Commons Attribution Licence, which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.

                History
                : 11 April 2016
                Funding
                Funded by: National Institutes of Health
                Award ID: U54 HD087011
                Award ID: K24 MH087913
                Award ID: R21 NS091635
                Award ID: K01 MH104592
                Award ID: K12 NS001690
                Research reported in this publication was supported by the Eunice Kennedy Shriver National Institute Of Child Health & Human Development of the National Institutes of Health (NIH) under Award Number U54 HD087011 to the Intellectual and Developmental Disabilities Research Center at Washington University, by NIH grants K24 MH087913, R21 NS091635, K01 MH104592, K12 NS001690, by the McDonnell Center for Systems Neuroscience at Washington University, by a NARSAD Young Investigator Award to DJG from the Brain & Behavior Research Foundation, and by the Tourette Association of America. The content is solely the responsibility of the authors and does not necessarily represent the official views of the National Institutes of Health or any of the other funders.
                The funders had no role in study design, data collection and analysis, decision to publish, or preparation of the manuscript.
                Categories
                Review
                Articles
                Motor Systems
                Movement Disorders

                provisional tic disorder,tourette syndrome,tic remission,tics

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