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Tics and functional tic-like movements: Can we tell them apart?
Abstract
Within the broad spectrum of movement disorders, tics and functional tic-like movements belong to a particular clinical category. Both types of movements are within the range of normal movement kinematics and muscle synergies, but appear repetitive and without appropriate context embedment. Historically, there have been many attempts to separate the 2 types of movements, but because of their phenomenological overlap, clinical distinction may be prone to error, and misdiagnoses may often occur. Most importantly, the 2 types of movement may coexist. Here, we review the available literature on the 2 types of motor phenomena and demonstrate some of the difficulties in distinguishing tics from functional tic-like movements on clinical grounds. We also highlight similarities and differences in pathophysiologic characteristics, documenting the significance of action monitoring, attentional allocation, and behavioral reinforcement in both types of movements, as well as in their risk factors. We discuss the overlap of current behavioral treatments for tics and functional tic-like movements and emphasize implications of diagnostic mislabeling. Such implications include the need to tailor behavioral treatment approaches to individual phenomenological profiles and guiding decision making for severe patients requiring invasive interventions, such as deep brain stimulation. A deeper insight from clinicians with respect to persisting challenges in classifying and differentiating these motor phenomena could accelerate the development of reliable clinical and physiologic markers (i.e., next generation phenotyping) and a neurobiology-driven therapeutic approach for these motor phenomena.
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“they are suggested to have unique psychological and pathophysiological underpinnings (15) and are best conceptualized using a biopsychosocial model (16, 17).”
From Integrated cognitive behavioral intervention for functional tics (I-CBiT): case reports and treatment formulation (2023) · cites this paper as [15]
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Metadata
- Authors
- Ganos, C., Martino, D., Espay, A. J., Lang, A. E., Bhatia, K. P., & Edwards, M. J.
- Affiliations
- St George's, University of London (GB)
- ORCID
- Venue
- Neurology
- Published
- 2019-10-22
- Volume
- 93
- Issue
- 17
- Pages
- 750-758
- ISSN
- 0028-3878 (ISSN-L)
- 1526-632X
- OpenAlex
- W2976239244
- Cited by
- 124
- References
- 60
- Citations by year
- 2026: 14 · 2025: 11 · 2024: 13 · 2023: 19 · 2022: 32 · 2021: 24 · 2020: 9 · 2019: 2
- FWCI
- 2.64
- Type
- journal article
- Language
- en
- Open access
- closed
- Locations
- Neurology (publishedVersion)
- PubMed (publishedVersion)
- St George's Online Research Archive (St George's University of London) (acceptedVersion)
- UCL Discovery (University College London) (submittedVersion)
- Topics
- Social Sciences › Psychology › Clinical Psychology › Obsessive-Compulsive Spectrum Disorders
- Health Sciences › Medicine › Clinical Neurology › Deep Brain Stimulation and Movement Disorders
- Health Sciences › Medicine › Clinical Neurology › Neurological and metabolic disorders
- Keywords
- tics, movement disorders, diagnosis, misdiagnosis, action monitoring, attention allocation, behavioral reinforcement, risk factors, behavior therapy, deep brain stimulation, phenotyping, motor kinematics, muscle synergies
- MeSH terms
- Animals, Diagnosis, Differential, Humans, Tic Disorders, Tics
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