Objective: To identify patterns of tic re-emergence in adult patients with a history of childhood tics.

Background: Tics and Tourette syndrome (TS) have been described as peaking in childhood and early adolescence with regression as patients enter adulthood. In this series, we report patients who belong to a little-described subset of TS patients: those who were diagnosed with TS during childhood who then experienced a period of relief from or absence of symptoms followed by tic re-emergence in adulthood.

Methods: We performed a retrospective chart review of outpatients over age 21 seen at the Yale Medical Group neurology clinic between January 2012 and July 2016 who were diagnosed by a movement disorders neurologist with childhood onset tics or TS, and who experienced a latent period of relative tic abatement (defined as a significant reduction in or absence of tics) followed by exacerbation.

Results: Sixteen patients were identified. The mean latent period of tic abatement was 16 years, range 3-35 years. Ten patients (62.5%) identified a trigger for their exacerbation; common triggers were work-related, interpersonal, or involved changes in substance use. Three patients (18.8%) reported that the phenomenology of their tics during the exacerbation had evolved since childhood, and seven patients (43.8%) reported that their tics were now worse. Six patients (37.5%) had received medications for tics as children, and 15 patients (93.8%) received pharmacological intervention for their tics during the adulthood exacerbation. Six of fifteen patients (40.0%) had a documented effective response from those pharmacological intervention(s).

Conclusions: 1) Our study, which represents the largest single series to date of adults with tic recurrences, raises the possibility that the steady decline in symptoms many patients experience as they enter their early 20s may in fact represent temporary improvement.  2) The period of tic abatement lasted years in our patients, different from the more rapid fluctuations in children. 3) As in children, psychosocial and vocational stressors were common triggers in this study, but substance-related issues may also be an important trigger in adults. 3) Patient desire for pharmacological intervention was not necessarily correlated with worsening tic severity. Treatment is challenging, and multiple medications may need to be trialed for optimal efficacy.

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MDS Abstracts - https://www.mdsabstracts.org/abstract/tics-exacerbations-in-adults-with-tic-disorders-a-case-series/