Hyperkinetic movement disorders misdiagnosed as tics in Gilles de la Tourette syndrome.
OBJECTIVE
To describe the gamut of movements misdiagnosed as tic exacerbations in Gilles de la Tourette syndrome (GTS) in a referral tertiary-care center.


BACKGROUND
Movements seen in GTS can be classified as: (a) tics; (b) movements related to conditions associated with GTS, specifically obsessive-compulsive disorder (OCD), attention deficit hyperactivity disorder (ADHD), and antisocial behaviors; and (c) movements secondary to treatment.


METHODS
We reviewed a videotape database and patient records from a tertiary treatment center for GTS and collected GTS cases referred for disease exacerbation who had both tics and non-tic movements thought by the referring physician, the patient, and the family to be an exacerbation of tics.


RESULTS
Of 373 GTS cases, 12 had movement disorders secondary to treatment, and six had non-tic movements related to conditions commonly associated with GTS. In the former group, there were 7 patients with acute akathisia, 3 with acute dystonia, 1 with tardive chorea, 1 with withdrawal emergent chorea, and 5 with tardive dystonia. Six had movement disorders related to non-tic conditions commonly associated with GTS: four patients had movements associated with OCD, one with ADHD and antisocial behavior, respectively.


CONCLUSIONS
There is a broad spectrum of movements in GTS that are not tics but can be misdiagnosed as tics. Clinical awareness of these movements is paramount to proper diagnosis and pharmacologic intervention.
Kompoliti
K
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Department of Neurology, Rush-Presbyterian-St. Luke's Medical Center, Chicago, Illinois 60612, USA.
Goetz
C G
CG
D000293:Adolescent; D000328:Adult; D017109:Akathisia, Drug-Induced / Q000175:diagnosis / Q000209:etiology; D014150:Antipsychotic Agents / Q000008:administration & dosage / Q000009:adverse effects; D000987:Antisocial Personality Disorder / Q000175:diagnosis; D001289:Attention Deficit Disorder with Hyperactivity / Q000175:diagnosis; D002648:Child; D002675:Child, Preschool; D003951:Diagnostic Errors; D004409:Dyskinesia, Drug-Induced / Q000175:diagnosis / Q000209:etiology; D005260:Female; D006801:Humans; D006948:Hyperkinesis / Q000175:diagnosis* / Q000209:etiology; D008297:Male; D009771:Obsessive-Compulsive Disorder / Q000175:diagnosis; D010348:Patient Care Team; D011595:Psychomotor Agitation / Q000175:diagnosis / Q000209:etiology; D012017:Referral and Consultation; D019956:Stereotypic Movement Disorder / Q000175:diagnosis / Q000209:etiology; D013981:Tic Disorders / Q000175:diagnosis* / Q000209:etiology; D005879:Tourette Syndrome / Q000175:diagnosis*; D014743:Videotape Recording
D014150:Antipsychotic Agents