Rapid onset functional tic like behaviours

Biography Dr. Tamara Pringsheim is a Professor with the Department of Clinical Neurosciences, Psychiatry, Pediatrics and Community Health Sciences at the University of Calgary. She is the program lead for the Tourette and Pediatric Movement Disorder program at Alberta Children’s Hospital and the Deputy Director of the Mathison Centre for Mental Health Research and Education. She also works as an evidence-based medicine methodologist for the American Academy of Neurology. She is the president of the Tourette OCD Alberta Network, a nonprofit organization that supports people living with Tourette syndrome and OCD in Alberta, and provides education and training on these disorders to healthcare providers. Objective To describe the clinical characteristics, phenomenology and outcomes of Rapid Onset Functional Tic Like Behaviours (FTLBs) in young people. Methods The presenter will review published data on the clinical characteristics, phenomenology and evolution of FTLBs arising in young people around the world during and after the COVID-19 pandemic. Results Since mid-2020, clinicians at Tourette syndrome clinics around the world have experienced an unprecedented number of referrals of young people who have developed the rapid onset of FTLBs. Case series from several countries have been published, with common phenomenological characteristics between samples. Affected individuals typically range from 12 to 25 years of age. The majority of cases reported were assigned female at birth. Symptom onset is sudden, typically reaching a peak in severity within hours to days. Functional motor tic like behaviours are dominated by large amplitude arm movements, clapping, throwing objects and hitting oneself or others. Functional vocal tic like behaviours include an assortment of random words and phrases, and socially inappropriate or offensive words and phrases. Patients with FTLBs present with high symptom severity and impairment scores and are likely to meet the clinical threshold for an anxiety disorder or major depressive disorder. Theories for such magnification of FTLBs during the COVID-19 pandemic include the possibility of social contagion illness spread through the medium of social media. Additional stressors through the pandemic, including school and extracurricular activity closures, ‘virtual schooling’ and associated academic pressures, social isolation and increased tensions at home during lockdown measures are believed to contribute to this clinical phenomenon. Emerging data on short- and medium-term outcomes suggests symptom improvement in the majority of individuals over a period of months, with treatment focusing on comorbid anxiety and depressive symptoms. Conclusions Rapid onset FTLBs have several distinguishing characteristics, appear strongly socially influenced, and show a positive response to treatment of distress, anxiety and mood disorders.

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