Tourette Syndrome and Other Tic Disorders Workup

Updated: May 30, 2019
  • Author: William C Robertson, Jr, MD; Chief Editor: Stephen L Nelson, Jr, MD, PhD, FAACPDM, FAAN, FAAP  more...
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Workup

Approach Considerations

When an appropriately experienced physician finds typical indications of Tourette syndrome (TS) in the patient's history and examination, no further workup is generally necessary. Further workup may be needed if unusual features are present in the history or physical examination or if other abnormalities are found on neurological examination.

Unusual findings may include rigidity, bradykinesia, spasticity, myoclonus, chorea, dementia, or psychosis. Further workup may include corroboration of the patient's history with that of another source, with clinical follow-up, or with laboratory testing.

Go to Pediatric Tourette Syndrome for complete information on this topic.

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Serum Ceruloplasmin or Slit-Lamp Examination

Serum ceruloplasmin or slit lamp examination for Kayser-Fleischer rings might be considered. This examination is not always necessary. However, if unusual features are present, these tests may lead to lifesaving measures by confirming the presence of Wilson disease.

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Neuropsychological Testing

Neuropsychological testing may be useful: Patients with difficulties in the school or work setting may benefit from an evaluation for learning disorders so that adaptive strategies can be identified.

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Imaging Studies

Structural imaging studies are not routinely needed in the evaluation of patients with a typical history and examination findings. These studies are indicated only to exclude specific illnesses suggested by abnormal history or examination findings.

At present, functional imaging studies have no proven clinical utility in the evaluation of tic disorders.

Data from unpublished reports suggest possible future clinical benefits of neuroimaging. For example, caudate volume in childhood is inversely associated with illness severity in adulthood. [155]

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