title: Tic Exacerbation in Adults with Tourette Syndrome: A Case Series.
abstract: BACKGROUND
  Tourette syndrome (TS) has been described as peaking in adolescence with subsequent regression. We report patients who were diagnosed with TS during childhood who experienced a latent period (significant reduction in or absence of tics) followed by tic re-emergence in adulthood.
  
  
  METHODS
  We performed a retrospective chart review of outpatients over age 21 seen at the Yale neurology clinic between January 2012 and July 2016 who were diagnosed with childhood-onset tics, and who experienced a latent period of greater than 1 year followed by an exacerbation.
  
  
  RESULTS
  Sixteen patients were identified. The mean latent period was 16 years. Ten patients (62.5%) identified an exacerbation trigger, most commonly changes in substance use (five patients). Seven patients (43.8%) reported worsening of tics since childhood. Six patients (37.5%) had received pharmacological intervention for tics as children, and 15 patients (93.8%) as adults. Six of 15 patients (40.0%) had an effective response from those pharmacological intervention(s).
  
  
  CONCLUSIONS
  Our study demonstrates that the decline in symptoms as patients age may represent temporary improvement. The latent period lasted years in our patients, different from the more rapid waxing and waning in children. A change in substance use was an important trigger. Requests for pharmacological intervention were not necessarily correlated with worsening tic severity.
authors.affiliation: Department of Neurology, Yale School of Medicine, Yale University, New Haven, CT, USA.
authors.forename: Sara M
authors.initials: SM
authors.lastname: Schaefer
authors.affiliation: Department of Neurology, Yale School of Medicine, Yale University, New Haven, CT, USA.
authors.forename: Christopher A
authors.initials: CA
authors.lastname: Chow
authors.affiliation: Department of Neurology, Yale School of Medicine, Yale University, New Haven, CT, USA; Department of Chronic Disease Epidemiology, Yale School of Public Health, Yale University, New Haven, CT, USA; Center for Neuroepidemiology and Clinical Neurological Research, Yale School of Medicine, Yale University, New Haven, CT, USA.
authors.forename: Elan D
authors.initials: ED
authors.lastname: Louis
authors.affiliation: Department of Neurology, Yale School of Medicine, Yale University, New Haven, CT, USA.
authors.forename: Daphne
authors.initials: D
authors.lastname: Robakis
keywords: Tics; Tourette syndrome