Objective: To examine the profile, associated conditions and risk factors among patients with abrupt onset of tic-like abnormal movements and vocalizations during the COVID pandemic.

Background: Typically, tic disorders start during early childhood, however, since the onset of the COVID pandemic, we have encountered an increased number of patients with an explosive onset of tic-like movements and vocalizations later in life. Although an abrupt onset of symptoms can be seen in patients with tic disorders, it is more often characteristic of functional neurological disorders.

Method: A chart review of new patients with a diagnosis of tic-like movements and vocalizations seen between March 2020 and March 2021 in a movement disorders clinic was conducted, and those with an acute onset of tics during this time were included in this report. Tic characteristics recorded included premonitory urge, suppressibility, and build-up. Risk factors and medical comorbidities for both tics and functional neurological disorder were reviewed including the presence of psychological or physical triggers coinciding with the onset of movements. Etiology of tics was based on the movement disorders specialist’s assessment.

Results: Ten patients with abrupt tic onset were identified. Nine patients were female. The median age at presentation was 19 (range 15-41) and duration of tics prior to the initial visit was 8 weeks (range 1-24). Two patients were diagnosed with a purely functional movement disorder, 4 with an organic tic disorder and 4 with both functional and organic tics. All patients presented with motor tics and 9 with vocal tics. Those with functional tics had no premonitory urge, build-up and their tics were not stereotypic. Nine patients had an identifiable trigger prior to onset of tics (1 physical and 8 psychological) and all patients had a history of anxiety.

Conclusion: Functional and organic tics share many common characteristics and can be difficult to differentiate. This phenotype of acute, explosive onset of tic-like movements and vocalizations in older adolescents and adults is novel to this pandemic.  Whether it is driven by the stress of life during a pandemic, suboptimally treated anxiety, or other, yet unidentified factors, warrants further investigation.

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MDS Abstracts - https://www.mdsabstracts.org/abstract/explosive-onset-of-tic-like-movements-during-the-covid-pandemic-among-patients-with-no-previous-diagnosis-of-tic-disorders/