title: Adult-onset tic disorder, motor stereotypies, and behavioural disturbance associated with antibasal ganglia antibodies.
abstract: The onset of tics in adulthood is rare and, unlike the childhood variety, there is commonly a secondary environmental cause. We present four cases (1 man, 3 women) with an adult onset tic disorder (mean age of onset, 36 years; range, 27-42 years) associated with the presence of serum antibasal ganglia antibodies (ABGA). One patient had motor tics and unusual motor stereotypies, 2 had multiple motor and vocal tics, and the remaining patient had motor tics only. Concomitant psychiatric disturbance was noted in 3 cases. In 2 cases, there was a close temporal relationship between upper respiratory tract infection and the subsequent onset of tics. Imaging was possible in three cases and was normal in two but revealed a lesion involving the right caudate and lentiform nuclei in the other. We suggest that there might be a causal relationship between ABGA and the clinical syndrome in these cases and that ABGA should be considered as a possible etiology for adult-onset tics.
authors.affiliation: Sobell Department of Movement Neuroscience and Movement Disorders, Institute of Neurology, University College London, Queen Square, London, United Kingdom.
authors.forename: Mark J
authors.initials: MJ
authors.lastname: Edwards
authors.forename: Russell C
authors.initials: RC
authors.lastname: Dale
authors.forename: Andrew J
authors.initials: AJ
authors.lastname: Church
authors.forename: Eleni
authors.initials: E
authors.lastname: Trikouli
authors.forename: Niall P
authors.initials: NP
authors.lastname: Quinn
authors.forename: Andrew J
authors.initials: AJ
authors.lastname: Lees
authors.forename: Gavin
authors.initials: G
authors.lastname: Giovannoni
authors.forename: Kailash P
authors.initials: KP
authors.lastname: Bhatia
mesh_terms: D000328:Adult; D017668:Age of Onset; D001323:Autoantibodies / Q000276:immunology*; D001479:Basal Ganglia / Q000276:immunology*; D001905:Botulinum Toxins / Q000627:therapeutic use; D001921:Brain / Q000473:pathology*; D004797:Enzyme-Linked Immunosorbent Assay; D005260:Female; D006801:Humans; D008279:Magnetic Resonance Imaging; D008297:Male; D001523:Mental Disorders / Q000175:diagnosis / Q000276:immunology; D009465:Neuromuscular Agents / Q000627:therapeutic use; D019956:Stereotypic Movement Disorder / Q000175:diagnosis / Q000276:immunology; D013981:Tic Disorders / Q000175:diagnosis* / Q000188:drug therapy / Q000276:immunology*
chemical_list: D001323:Autoantibodies; D009465:Neuromuscular Agents; D001905:Botulinum Toxins