Department of Neurology, Massachusetts General Hospital, Boston, Massachusetts.
Department of Neurology, Massachusetts General Hospital, Boston, Massachusetts; Department of Clinical Psychology, Kent State University, Kent, Ohio.
Pediatr Neurol. 2024 Jun;155:182-186. doi: 10.1016/j.pediatrneurol.2024.03.027. Epub 2024 Apr 5.
Functional tic disorders are among the least common functional movement disorders, but their prevalence rose during the coronavirus disease 2019 (COVID-19) pandemic. Although female adolescents develop functional neurological disorders at higher rates than males, investigations into sexual orientation and gender identity (SOGI) status of these patients are limited.
We completed a retrospective, cross-sectional time series examining the incidence of new-onset functional tic disorders in youth presenting to the Massachusetts General Hospital Movement Disorder clinics before and during the COVID-19 pandemic. Data were collected by searching for relevant International Classification of Diseases (ICD)-10 diagnostic codes in youth aged nine to 26 years using a hospital-wide data repository. Individual cases were reviewed for inclusion based on clinical criteria and expert consensus.
The prevalence of functional tic presentations in youth rose 8.6-fold from pre- to postpandemic levels (Fisher exact test P < 0.001), whereas the prevalence of developmental tic presentations pre- and postpandemic remained stable (114 vs 112). SOGI minority youth comprised 37% of those with functional tics (total n = 19). Ninety five percent of patients with functional tics identified as female, with 10% of these identifying as transgender.
Our data confirm previously demonstrated dramatic rises in functional tic presentations during the COVID-19 pandemic and, more notably, reveal a strong association with SOGI minority status. We highlight the potential link between functional tic disorders and SOGI minority status. Providing a safe and supportive clinical environment and addressing stress linked to SOGI minority status may help to improve patient prognosis.
功能性运动障碍是最常见的功能性运动障碍之一，但在 2019 年冠状病毒病（COVID-19）大流行期间，其发病率有所上升。尽管女性青少年比男性更容易患上功能性神经障碍，但对这些患者的性取向和性别认同（SOGI）状况的调查有限。
我们进行了一项回顾性、横断面时间序列研究，调查了 COVID-19 大流行前后在马萨诸塞州综合医院运动障碍诊所就诊的青少年新发功能性抽动障碍的发病率。通过在一个医院范围内的数据存储库中搜索与国际疾病分类（ICD-10）相关的诊断代码，来收集 9 至 26 岁青少年的数据。根据临床标准和专家共识，对个别病例进行了审查，以确定是否符合纳入标准。
青少年功能性抽动症的患病率从大流行前到大流行后增加了 8.6 倍（Fisher 精确检验 P<0.001），而大流行前和大流行后的发育性抽动症患病率保持稳定（114 例比 112 例）。SOGI 少数族裔青少年占功能性抽动症患者的 37%（共 19 例）。95%的功能性抽动症患者为女性，其中 10%为跨性别者。
我们的数据证实了之前在 COVID-19 大流行期间功能性抽动症发生率显著上升的研究结果，更值得注意的是，这与 SOGI 少数族裔身份有很强的关联。我们强调了功能性抽动障碍与 SOGI 少数族裔身份之间的潜在联系。提供一个安全和支持性的临床环境，并解决与 SOGI 少数族裔身份相关的压力，可能有助于改善患者的预后。
