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Tics and Parkinson's Disease: Clinical and Pathophysiological Insights from a Rare Syndromic Association
Tarig Abkur1,2,3, Alexandra Boogers1,2, Talyta Grippe1,2
1Edmond J. Safra Program in Parkinson's Disease, Morton and Gloria Shulman Movement Disorders Clinic, Toronto Western Hospital, University Health Network, Toronto, Ontario, Canada.
Background:
The coexistence of tics with Parkinson's disease (PD) is rare, as they often emerge at different ages, follow different trajectories and involve contrasting pathophysiological mechanisms related to dopamine availability and function in the brain.
Cases:
We present 10 individuals with primary tic disorders who later developed PD. Tic severity remained unchanged with the onset of parkinsonism or dopaminergic treatment. Peak-dose dyskinesias in two cases did not affect tics, and deep brain stimulation of the subthalamic nucleus transiently induced tics in one individual with PD.
Conclusions:
The evidence drawn from this case series does not support a linear relation between nigrostriatal dopaminergic availability and tics. It suggests that tics may instead arise from a more complex interplay between multiple neurotransmitter systems acting on several networks within the cortico-striatal-thalamic circuits.
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