Objective: The aim of this case series is to add to the limited existing reports on the demographics, clinical history, phenomenology, and treatment response of patients with functional tic-like behavior (FTLB), with the addition of gender-identity associations.

Background: Reported numbers of young adults presenting with FTLB has increased in the last several years, related in part to the COVID-19 pandemic and social media usage [1]. Patients with FTLB are predominantly young females with a rapid onset of symptoms [2]. To date, gender identity has not been assessed. Reported response to therapy and medications has been variable.

Method: This single-center case series included patients that presented to the Northwestern University Parkinson’s Disease and Movement Disorders Center with FTLB between February and September 2021.

Results: The mean age of onset and diagnosis were 22 and 22.4 years old (n=8), respectively. All patients were assigned female sex at birth, and 5 (62.5%) identified their gender as non-binary. Three patients had comorbid functional movement disorders and/or functional seizures (37.5%). The majority of patients (n=7, 87.5%) had depression and anxiety, 2 (25%) had ADHD, and 2 (25%) had OCD. Three-quarters (n=6, 75%) of patients were on antidepressants or mood stabilizers. Half (n=4, 50%) of the patients used substances, including nicotine, alcohol, marijuana, or illicit drugs. One patient had isolated motor tics and the rest (n=7, 87.5%) had complex motor and verbal tic-like movements with frequent self-injurious behavior. All patients were recommended to start comprehensive behavioral intervention for tics with habit reversal therapy (CBIT/HRT), guanfacine, and gingko biloba. One year follow up was available for 5 patients. Tics improved in 2 patients (25%) following CBIT/HRT and in 1 patient (12.5%) using guanfacine and gingko biloba. Tics were stable in 2 patients (25%) without intervention.

Conclusion: Concordant to other studies, all patients were young adults of female sex, with abrupt onset of FTLB during the COVID-19 pandemic. Interestingly, the majority identified their gender as non-binary. Several patients experienced tic reduction after using CBIT/HRT, alpha-agonists, and/or gingko biloba, suggesting that they may be beneficial treatment options in this unique population.

References: 1. Olvera, C., et al., TikTok Tics: A Pandemic Within a Pandemic. Mov Disord Clin Pract, 2021. 8(8): p. 1200-1205.
2. Pringsheim, T., et al., Rapid Onset Functional Tic-Like Behaviors in Young Females During the COVID-19 Pandemic. Mov Disord, 2021. 36(12): p. 2707-2713.

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MDS Abstracts - https://www.mdsabstracts.org/abstract/gender-identity-and-treatment-response-in-patients-with-functional-tic-like-behavior/