Chouinard S, Ford B
Department of Neurology, University of Montreal, Quebec, Canada.
J Neurol Neurosurg Psychiatry. 2000 Jun;68(6):738-43. doi: 10.1136/jnnp.68.6.738.
Tic disorders presenting during adulthood have infrequently been described in the medical literature. Most reports depict adult onset secondary tic disorders caused by trauma, encephalitis, and other acquired conditions. Only rare reports describe idiopathic adult onset tic disorders, and most of these cases represent recurrent childhood tic disorders.
To describe a large series of patients with tic disorders presenting during adulthood, to compare clinical characteristics between groups of patients, and to call attention to this potentially disabling and underrecognised neurological disorder.
Using a computerised database, all patients with tic disorders who presented between 1988 and 1998 to the movement disorders clinic at Columbia-Presbyterian Medical Center after the age of 21 were identified. Patients' charts were retrospectively reviewed for demographic information, age of onset of tics, tic phenomenology, distribution, the presence of premonitory sensory symptoms and tic suppressibility, family history, and associated psychiatric features. These patients' videotapes were reviewed for diagnostic confirmation and information was obtained about disability, course, and response to treatment in a structured follow up interview.
Of 411 patients with tic disorders in the database, 22 patients presented for the first time with tic disorders after the age of 21. In nine patients, detailed questioning disclosed a history of previous childhood transient tic disorder, but in 13 patients, the adult onset tic disorder was new. Among the new onset cases, six patients developed tics in relation to an external trigger, and could be considered to have secondary tic disorders. The remaining patients had idiopathic tic disorders. Comparing adult patients with recurrent childhood tics and those with new onset adult tics, the appearance of the tic disorder, the course and prognosis, the family history of tic disorder, and the prevalence of obsessive-compulsive disorder were found to be similar. Adults with new onset tics were more likely to have a symptomatic or secondary tic disorder, which in this series was caused by infection, trauma, cocaine use, and neuroleptic exposure.
Adult onset tic disorders represent an underrecognised condition that is more common than generally appreciated or reported. The clinical characteristics of adults newly presenting to a movement disorder clinic with tic disorders are reviewed, analysed, and discussed in detail. Clinical evidence supports the concept that tic disorders in adults are part of a range that includes childhood onset tic disorders and Tourette's syndrome.
成年期出现的抽动障碍在医学文献中鲜有描述。大多数报告描述的是由创伤、脑炎及其他后天性疾病引起的成年起病的继发性抽动障碍。仅有少数报告描述特发性成年起病的抽动障碍，且其中大多数病例为儿童期复发性抽动障碍。
描述一大组成年期出现抽动障碍的患者，比较各患者组之间的临床特征，并引起对这种可能致残且未得到充分认识的神经障碍的关注。
利用计算机化数据库，确定了1988年至1998年间21岁以后到哥伦比亚长老会医学中心运动障碍门诊就诊的所有抽动障碍患者。回顾患者病历以获取人口统计学信息、抽动起病年龄、抽动现象学、分布情况、先兆感觉症状的存在及抽动抑制性、家族史以及相关精神特征。复查这些患者的录像带以进行诊断确认，并通过结构化随访访谈获取有关残疾情况、病程及治疗反应的信息。
数据库中的411例抽动障碍患者中，22例在21岁以后首次出现抽动障碍。9例患者经详细询问发现有儿童期短暂性抽动障碍病史，但13例患者的成年起病抽动障碍为新发。在新发病例中，6例患者的抽动与外部诱因有关，可认为患有继发性抽动障碍。其余患者患有特发性抽动障碍。比较成年期复发性抽动障碍患者和成年期新发抽动障碍患者，发现抽动障碍的表现、病程和预后、抽动障碍家族史以及强迫症患病率相似。成年期新发抽动障碍患者更有可能患有症状性或继发性抽动障碍，在本系列中，其病因包括感染、创伤、使用可卡因及接触抗精神病药物。
成年起病的抽动障碍是一种未得到充分认识的疾病，其比一般认为或报告的更为常见。对新到运动障碍门诊就诊的成年抽动障碍患者的临床特征进行了详细的回顾、分析和讨论。临床证据支持这样的观点，即成人抽动障碍是包括儿童期起病的抽动障碍和图雷特综合征在内的一系列疾病的一部分。
