Functional tics and tic-like behaviors

Area of Science:

• Neurology
• Neuroscience
• Psychiatry

Background:

• Functional tics and tic-like behaviors are part of functional movement disorders.
• Historically uncommon, functional tic disorders have seen a notable increase in reported cases over the past decade, peaking during the COVID-19 pandemic.
• This rise presents diagnostic and treatment challenges while driving research for better clinical understanding and criteria.

Purpose of the Study:

• To provide a historical overview of the neurodevelopmental versus functional tics debate.
• To review literature on functional tics and tic-like behaviors, detailing their key features.
• To discuss diagnostic and therapeutic approaches for functional tics.

Main Methods:

• Literature review tracking cases of functional tics and tic-like behaviors.
• Analysis of salient clinical features, onset, symptom variability, and comorbidities.
• Discussion of neurophysiologic evaluation techniques and management strategies.

Main Results:

• Functional tics often present with acute onset, severe symptoms, complex behaviors, and variability, typically in late adolescence/early adulthood.
• Common features include vocalizations with swear words/sentences, spontaneous remissions, and overlap with other functional neurologic symptoms like tremor or seizures.
• Neurophysiologic markers (e.g., Bereitschaftspotential) may aid diagnosis in challenging cases.

Conclusions:

• Accurate diagnosis is crucial for managing functional tics, often requiring a multidisciplinary approach.
• Cognitive-behavioral therapy and Comprehensive Behavioral Intervention for Tics are beneficial, alongside managing psychiatric comorbidities.
• Individualized care plans are most effective due to the lack of standardized treatment protocols.