Müller-Vahl Kirsten R, Pisarenko Anna, Fremer Carolin, Haas Martina, Jakubovski Ewgeni, Szejko Natalia
Clinic of Psychiatry, Social Psychiatry and Psychotherapy, Hannover Medical School, Hannover, Germany.
Department of Clinical Neurosciences, University of Calgary, Calgary, Alberta, Canada.
Mov Disord Clin Pract. 2024 Mar;11(3):227-237. doi: 10.1002/mdc3.13932. Epub 2023 Dec 12.
Comorbid functional tic-like behaviors (FTB) have been described only rarely in patients with Tourette syndrome (TS).
We present the first large sample of patients suffering from TS and FTB to raise awareness of this clinical presentation and to guide how to differentiate one from the other.
We analyzed clinical data of 71 patients (n = 27 [38.0%] female, mean age: 21.5, range: 11-55) with TS + FTB.
In the majority of patients, FTB started abruptly on average 15 years after tic onset with "treatment-resistant" complex movements and ("coprophenomena-like") vocalizations preceded by timely related psychological stressors. Psychological evaluation revealed evidence for internal conflicts (79%), emotional dysregulation (56%), and maintaining factors (70%). About one third of patients had a positive history for further medically unexplained symptoms. Compared to a large TS sample (n = 1032), patients with TS + FTB were more likely to be female, and presented significantly more common with "coprophenomena-like" symptoms, atypical influential factors, atypical descriptions of premonitory sensations, and higher rates of comorbid obsessive-compulsive disorder and "self-injurious" behavior.
Based on our data it can be assumed that FTB is a common comorbidity in TS, similar to functional overlay in other movement disorders and epilepsy. Before classifying a patient as suffering from treatment-resistant TS, FTB should be ruled out.
共病的功能性抽动样行为（FTB）在 Tourette 综合征（TS）患者中仅有极少的描述。
我们呈现了首个患有 TS 和 FTB 的大样本患者，以提高对这种临床表现的认识，并指导如何区分两者。
我们分析了 71 例患有 TS + FTB 的患者（n = 27 [38.0%] 为女性，平均年龄：21.5 岁，范围：11 - 55 岁）的临床数据。
在大多数患者中，FTB 平均在抽动发作后 15 年突然起病，伴有“治疗抵抗性”复杂运动和（“类秽语症样”）发声，之前有及时相关的心理应激源。心理评估显示存在内心冲突（79%）、情绪调节障碍（56%）和维持因素（70%）的证据。约三分之一的患者有进一步医学无法解释症状的阳性病史。与一个大的 TS 样本（n = 1032）相比，患有 TS + FTB 的患者更可能为女性，并且更常出现“类秽语症样”症状、非典型影响因素、对先兆感觉的非典型描述，以及更高的共病强迫症和“自我伤害”行为发生率。
基于我们的数据，可以假设 FTB 是 TS 中一种常见的共病，类似于其他运动障碍和癫痫中的功能性叠加。在将患者归类为患有治疗抵抗性 TS 之前，应排除 FTB。
