Tourette Syndrome with Functional Overlay: A Case Series
Open accessAbstract
Functional tics have long been described as part of the much wider spectrum of functional neurological disorders with motor manifestations. Reports of functional tics have been relatively rare, until their recent increase on a global scale during the COVID-19 pandemic. Such reports have often been characterized by an acute or subacute onset of complex motor and vocal manifestations. Moreover, functional tics have predominantly been reported in adolescent females, whereas neurodevelopmental tics, such as those reported by patients with Tourette syndrome (TS), typically begin in younger boys. In addition to their marked severity and complexity, functional tics can merge into other types of functional neurological disorders. However, functional tics can also coexist with neurodevelopmental tics, as patients diagnosed with TS can present with a functional overlay (dual diagnosis). In the present study, we report the clinical characteristics of a case series of 10 patients diagnosed with both TS and functional tics during the COVID-19 pandemic. We also provide the first within-subject comparison between neurodevelopmental tics and functional tics, to assist clinicians in the differential diagnosis of patients with TS who developed a functional overlay during challenging times.
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More recent reports emphasize the role of anxiety in complex tic presentations and note that FTLBs often co-exist alongside neurodevelopmental tics.
“More recent reports emphasize the role of anxiety in complex tic presentations, noting that FTLBs often co-exist alongside neurodevelopmental tics and that this dual diagnosis has increased in recent years and/or been previously underestimated (20, 22, 23).”
From Integrated cognitive behavioral intervention for functional tics (I-CBiT): case reports and treatment formulation (2023) · cites this paper as [22]
The Introduction says functional tics can coexist with neurodevelopmental tics as a dual diagnosis, and the Discussion reports that 70% of the case-series patients had an anxiety disorder. The paper does not establish that anxiety plays a causal role, nor does it show that the dual diagnosis itself has increased or was previously underestimated; it describes a recent increase in reports of functional tics. (LLM, conf=0.83)
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Cites
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1 of the 21 references couldn’t be matched to a known paper.
Research works printed but not linked: 1
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Sorted by citations
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- Authors
- Cavanna, A. E., Damodaran, L., Purpura, G., & Nacinovich, R.
- Affiliations
- Aston University (GB)
- Birmingham Women’s and Children’s NHS Foundation Trust (GB)
- University of Milano-Bicocca (IT)
- Corresponding author
- Cavanna, Andrea E.
- Venue
- Archives of Medicine and Health Sciences
- Published
- 2022-07
- Volume
- 10
- Issue
- 2
- Pages
- 312-316
- ISSN
- 2321-4848 (ISSN-L)
- OpenAlex
- W4312297327
- Cited by
- 7
- References
- 21
- Citations by year
- 2026: 2 · 2025: 1 · 2024: 1 · 2023: 3
- FWCI
- 1.14
- Type
- journal article
- Language
- en
- Open access
- diamond
- doi.org
- Licence
- cc-by-nc-sa
- Locations
- Archives of Medicine and Health Sciences (publishedVersion, cc-by-nc-sa)
- BOA (University of Milano-Bicocca) (submittedVersion, cc-by-nc-sa)
- DOAJ (DOAJ: Directory of Open Access Journals) (submittedVersion)
- Topics
- Social Sciences › Psychology › Clinical Psychology › Obsessive-Compulsive Spectrum Disorders
- Health Sciences › Medicine › Psychiatry and Mental health › Psychosomatic Disorders and Their Treatments
- Social Sciences › Psychology › Clinical Psychology › Stuttering Research and Treatment
- Keywords
- Tourette syndrome, conversion disorder, dual diagnosis, COVID-19 pandemic, differential diagnosis, adolescent girls
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