eMedicine Specialties > Pediatrics: Developmental and Behavioral > Medical Topics

Tourette Syndrome: Differential Diagnoses & Workup

Author: Jason S Hawley, MD, Chief of Neurology, Carl R Darnall Army Medical Center
Coauthor(s): Sharette K Gray, MD, Chief of Outpatient Psychiatry, Carl R Darnall Army Medical Center
Contributor Information and Disclosures

Updated: Jun 23, 2008

Differential Diagnoses

Anxiety Disorders
Stimulants
Attention Deficit Hyperactivity Disorder
Systemic Lupus Erythematosus
Autistic Spectrum Disorders
Toxicity, Cocaine
Huntington Disease Dementia
Wilson Disease
Obsessive-Compulsive Disorder

Other Problems to Be Considered

Tuberous sclerosis
Neuroacanthocytosis
Dystonia
Hallervorden-Spatz disease
Neurofibromatosis type 1
Chromosomal disorders
Sydenham chorea
Motor restlessness
Akathisia
Excessive startle


Transient tic disorder of childhood: This syndrome is similar to TS, but it lasts for less than a year.

Chronic multiple tic disorder: This has a great similarity to TS but remains present in adulthood.

Chronic single tic disorder: This is a motor or vocal tic in adulthood. Since patients with TS can have multiple behavioral disorders, other DSM-IV-TR diagnoses to consider are depression, OCD, and personality disorders.

Workup

Laboratory Studies

  • Tourette syndrome (TS) is a clinical diagnosis; therefore, no specific laboratory or genetic tests exist to help establish the diagnosis. The keys to diagnosis are recognition and an index of suspicion.

Imaging Studies

  • Routine community based neuroimaging (CT and MRI) studies are normal in patients with TS.
  • Neuroimaging studies performed on a research basis have yielded subtle abnormalities that may give clues to understanding the pathophysiology of TS. 
    • Children and adults with TS have reduced caudate volumes compared with controls. Moreover, recent studies have suggested that the degree of volume reduction within the caudate nucleus correlates with the severity of tics and OCD.
    • Event-related functional MRI studies of patients with tics have indicated that paralimbic and sensory association areas are critically implicated in tic generation, similar to movements triggered internally by unpleasant sensations, as has been shown for pain or itching.
    • Positron-emission tomography (PET) studies have also shown increased activity in sensomotor, paralimbic, language, and frontal subcortical regions that were event-related to motor and phonic tics, as well as the compulsions to perform these behaviors.

More on Tourette Syndrome

Overview: Tourette Syndrome
Differential Diagnoses & Workup: Tourette Syndrome
Treatment & Medication: Tourette Syndrome
Follow-up: Tourette Syndrome
References
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References

  1. Jankovic J. Tourette's syndrome. N Engl J Med. Oct 18 2001;345(16):1184-92. [Medline].

  2. Bohlhalter S, Goldfine A, Matteson S, Garraux G, Hanakawa T, Kansaku K, et al. Neural correlates of tic generation in Tourette syndrome: an event-related functional MRI study. Brain. Aug 2006;129:2029-37. [Medline].

  3. Comella CL. Gilles de la Tourette's syndrome and other tic disorders. CONTINUUM: Lifelong Learning in Neurology. June 2004;10 (3):128-41.

  4. Alsobrook JP 2nd, Pauls DL. The genetics of Tourette syndrome. Neurol Clin. May 1997;15(2):381-93. [Medline].

  5. Singer HS, Hong JJ, Yoon DY, Williams PN. Serum autoantibodies do not differentiate PANDAS and Tourette syndrome from controls. Neurology. Dec 13 2005;65(11):1701-7. [Medline].

  6. Tanner CM, Goldman SM. Epidemiology of Tourette syndrome. Neurol Clin. May 1997;15(2):395-402. [Medline].

  7. Kadesjo B, Gillberg C. Tourette's disorder: epidemiology and comorbidity in primary school children. J Am Acad Child Adolesc Psychiatry. May 2000;39(5):548-55. [Medline].

  8. Cheung MY, Shahed J, Jankovic J. Malignant Tourette syndrome. Mov Disord. Sep 15 2007;22(12):1743-50. [Medline].

  9. Simonic I, Nyholt DR, Gericke GS, Gordon D, Matsumoto N, Ledbetter DH, et al. Further evidence for linkage of Gilles de la Tourette syndrome (GTS) susceptibility loci on chromosomes 2p11, 8q22 and 11q23-24 in South African Afrikaners. Am J Med Genet. Mar 8 2001;105(2):163-7. [Medline].

  10. A complete genome screen in sib pairs affected by Gilles de la Tourette syndrome. The Tourette Syndrome Association International Consortium for Genetics. Am J Hum Genet. Nov 1999;65(5):1428-36. [Medline].

  11. Anca MH, Giladi N, Korczyn AD. Ropinirole in Gilles de la Tourette syndrome. Neurology. May 11 2004;62(9):1626-7. [Medline].

  12. Bloch MH, Leckman JF, Zhu H, Peterson BS. Caudate volumes in childhood predict symptom severity in adults with Tourette syndrome. Neurology. Oct 25 2005;65(8):1253-8. [Medline].

  13. Bruun RD, Budman CL. The course and prognosis of Tourette syndrome. Neurol Clin. May 1997;15(2):291-8. [Medline].

  14. Chappell PB, Scahill LD, Leckman JF. Future therapies of Tourette syndrome. Neurol Clin. May 1997;15(2):429-50. [Medline].

  15. Como PG. Tourette syndrome. Neuropsychological tests for obsessive-compulsive disorder and attention deficit hyperactivity disorder. Neurol Clin. May 1997;15(2):255-65. [Medline].

  16. Freeman RD. Attention deficit hyperactivity disorder in the presence of Tourette syndrome. Neurol Clin. May 1997;15(2):411-20. [Medline].

  17. Kompoliti K, Goetz CG. Tourette syndrome. Clinical rating and quantitative assessment of tics. Neurol Clin. May 1997;15(2):239-54. [Medline].

  18. Kumar R, Lang AE. Tourette syndrome. Secondary tic disorders. Neurol Clin. May 1997;15(2):309-31. [Medline].

  19. Kurlan R. Future direction of research in Tourette syndrome. Neurol Clin. May 1997;15(2):451-6. [Medline].

  20. Kurlan R. Tourette syndrome. Treatment of tics. Neurol Clin. May 1997;15(2):403-9. [Medline].

  21. Kurlan R. Tourette's syndrome. In: Movement Disorders, Neurologic Principles and Practice. 2nd edition. New York: The McGraw-Hill Companies, Inc.; 2004:659-692.

  22. Kurlan R, Como PG, Miller B, Palumbo D, Deeley C, Andresen EM, et al. The behavioral spectrum of tic disorders: a community-based study. Neurology. Aug 13 2002;59(3):414-20. [Medline].

  23. Leckman JF, Peterson BS, Pauls DL. Tic disorders. Psychiatr Clin North Am. Dec 1997;20(4):839-61. [Medline].

  24. Marcus D, Kurlan R. Tics and its disorders. Neurol Clin. Aug 2001;19(3):735-58, viii. [Medline].

  25. Marras C, Andrews D, Sime E, Lang AE. Botulinum toxin for simple motor tics: a randomized, double-blind, controlled clinical trial. Neurology. Mar 13 2001;56(5):605-10. [Medline].

  26. Miguel EC, Rauch SL, Jenike MA. Obsessive-compulsive disorder. Psychiatr Clin North Am. Dec 1997;20(4):863-83. [Medline].

  27. Packer LE. Social and educational resources for patients with Tourette syndrome. Neurol Clin. May 1997;15(2):457-73. [Medline].

  28. Pranzatelli MR. Movement disorders in childhood. Pediatr Rev. Nov 1996;17(11):388-94. [Medline].

  29. Robertson MM, Banerjee S, Kurlan R, Cohen DJ, Leckman JF, McMahon W, et al. The Tourette syndrome diagnostic confidence index: development and clinical associations. Neurology. Dec 10 1999;53(9):2108-12. [Medline].

  30. Shavitt RG, Hounie AG, Rosario Campos MC, Miguel EC. Tourette's Syndrome. Psychiatr Clin North Am. Jun 2006;29(2):471-86. [Medline].

  31. Singer HS. Tourette's syndrome: from behaviour to biology. Lancet Neurol. Mar 2005;4(3):149-59. [Medline].

  32. Visser-Vandewalle V, Ackermans L, van der Linden C, Temel Y, Tijssen MA, Schruers KR, et al. Deep brain stimulation in Gilles de la Tourette's syndrome. Neurosurgery. Mar 2006;58(3):E590. [Medline].

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Further Reading

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Keywords

Tourette syndrome, tic, motor tic, phonic tic, vocal tic, Tourette, obsessive-compulsive disorder, OCD, attention deficit hyperactivity disorder, ADHD, TS psychopathology, large dorsolateral prefrontal region, increased cortical white matter in the right frontal lobe, dopamine supersensitivity

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Contributor Information and Disclosures

Author

Jason S Hawley, MD, Chief of Neurology, Carl R Darnall Army Medical Center
Jason S Hawley, MD is a member of the following medical societies: American Academy of Neurology
Disclosure: Nothing to disclose.

Coauthor(s)

Sharette K Gray, MD, Chief of Outpatient Psychiatry, Carl R Darnall Army Medical Center
Sharette K Gray, MD is a member of the following medical societies: American Academy of Child and Adolescent Psychiatry, American Medical Association, and American Psychiatric Association
Disclosure: Nothing to disclose.

Medical Editor

Jennifer S Morse, MD, Assistant Clinical Professor, Department of Psychiatry, University of California at San Diego
Jennifer S Morse, MD is a member of the following medical societies: Academy of Psychosomatic Medicine, Aerospace Medical Association, and American Psychiatric Association
Disclosure: Nothing to disclose.

Pharmacy Editor

Francisco Talavera, PharmD, PhD, Senior Pharmacy Editor, eMedicine
Disclosure: eMedicine Salary Employment

Managing Editor

Eduardo Dunayevich, MD, Adjunct Assistant Professor, Department of Psychiatry, University of Cincinnati; Clinical Research Physician, Neuroscience, Lilly Research Laboratories
Eduardo Dunayevich, MD is a member of the following medical societies: American Psychiatric Association
Disclosure: Nothing to disclose.

CME Editor

Harold H Harsch, MD, Program Director of Geropsychiatry, Department of Geriatrics/Gerontology, Associate Professor, Department of Psychiatry and Department of Medicine, Froedtert Hospital, Medical College of Wisconsin
Harold H Harsch, MD is a member of the following medical societies: American Psychiatric Association
Disclosure: lilly Honoraria Speaking and teaching; Forest Labs Honoraria Speaking and teaching; AstraZeneca Honoraria Speaking and teaching; Pfizer Grant/research funds Speaking and teaching; Northstar Grant/research funds Research; Novartis Grant/research funds research; Pfizer  Speaking and teaching; Sanofi-avetis Grant/research funds research; Otsuke Grant/research funds reseach; GlaxoSmithKline Grant/research funds research

Chief Editor

Stephen Soreff, MD, President of Education Initiatives, Nottingham, NH; Faculty, Metropolitan College of Boston University, Boston, MA
Stephen Soreff, MD is a member of the following medical societies: American College of Mental Health Administration and American Psychosomatic Society
Disclosure: Nothing to disclose.

 
 
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