Objective: To emphasize the association between seizures and a seemingly uncomplicated case of tics

Background:
Tics are a form  hyperkinetic movement disorder , which predominantly occur in the paediatric population with a prevalence  ranging around 3% ¹.Despite being grouped under the group of hyperkinetic disorders , tics stand apart from the rest under this classification with respect to its clinical attributes . Unlike the other hyperkinesias , tics  are typically preceded by a premonitory sensation known as the “premonitory urge² and have a vast range of phenomenology ^3,4

Method: Case report :A 8 year old boy born out of a non-consanguineous marriage with a normal perinatal and developmental history was brought to the hospital with complains of abnormal, repetitive movements of the face , neck and arms since 6 months . The movements were purposeless , repetitive involving the eyes ,mouth and shoulder. Clinical examination , routine blood work neuroimaging were normal.In view of history of concurrent , infrequent jerks  an Electroencephalogram( EEG )   was performed . EEG done revealed bursts of frontally dominant generalized spike wave discharges ( figures 1,2).The child was started on  valproic acid along with behavioral therapy .He is currently on follow up and frequency of the jerky movements have significantly reduced

Results: Tics are a set of hyperkinetic movements disorders , mainly seen in the pediatric population , which can be primary or secondary in nature ¹. They are charecterized by several attributes which set them apart from the other hyperkinesias including a varying range of phenomenology  ^2,3 .  The most common association of tics is with  ADHD or OCD^1,. The association between tics and seizures however are much rarer. Two large studies ^5,6,  found the prevalence of epilepsy to be  1.9 and 6 % of the study cohort respectively,  emphasizing the rarity of epilepsy in uncomplicated tics . In our patient , the unique features include the absence of a learning disability  or  structural abnormality in the brain . The jerk like movements described by the mother were subtle and differentiating the two was a diagnostic challenge .

Conclusion: While it is common knowledge that tics are associated with learning disabilities and psychiatric disorders , the rarer association of epilepsy must also be kept in mind . Our case report ,highlights this uncommon association and drives home the importance of being vigilant when managing a case of seemingly uncomplicated tics .

References: References: 1. Knight T, Steeves T, Day L, Lowerison M, Jette N, Pringsheim T. Prevalence of tic disorders: a systematic review and meta‐analysis. Pediatr Neurol 2012;47:77–90. 2. Ganos C, Martino D, Pringsheim T. Tics in the Pediatric Population: Pragmatic Management. Mov Disord Clin Pract. 2017 Mar-Apr;4(2):160-172. doi: 10.1002/mdc3.12428. 3. Hallett M. Neurophysiology of tics. Adv Neurol 2001;85:237–244. 4. Jankovic J, Fahn S. The phenomenology of tics. Mov Disord 1986;1:17–26. 5. Mejia, Nicte I, & Jankovic, Joseph. (2005). Secondary tics and tourettism. Brazilian Journal of Psychiatry, 27(1), 11-17 6. Williams, David & Stern, Jeremy & Grabecki, Kathryn & Simmons, Helen & Robertson, Mary. (2013). Epilepsy in Tourette Syndrome. Journal of neurology, neurosurgery, and psychiatry. 84. x-e1. 10.1136/jnnp-2013-306103.31.

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