Acute tic exacerbations: Tic status, malignant Tourette syndrome, tic attacks, tic fits, and other misfits

Acute tic exacerbations in Tourette syndrome (TS) and other tic disorders are influenced by biologic, psychologic, and social factors. Different terms have been used to describe acute tic exacerbations, including tic status, malignant TS, tic attacks, and tic fits. This review traces the evolution of our understanding of acute tic exacerbations and examines the emerging clinical constructs, highlighting the overlapping features and diagnostic ambiguities of such episodes. Common features include repetitive movements lasting from minutes to hours that are rarely suppressible, cause significant distress, functional impairment, and often require medical intervention. The complexity of these conditions and the potential co-occurrence of functional symptoms in some cases can complicate recognition of underlying triggers and appropriate management. Accurate differentiation from other hyperkinetic movement disorders demands a comprehensive assessment encompassing medical, pharmacologic, and psychiatric histories. By synthesizing current literature, this chapter aims to lay the groundwork for improving diagnostic precision and treatment, emphasizing the need for further research into the various mechanisms of acute tic exacerbations.