Parkinson's Disease Center and Movement Disorders Clinic, Department of Neurology, Baylor College of Medicine, Houston, TX, USA.
Department of Sciences and Engineering, University of Guanajuato, Ave León 428, Jardines del Moral, C.P. 37320, León, Guanajuato, México.
J Neurol. 2024 Nov;271(11):7232-7238. doi: 10.1007/s00415-024-12707-4. Epub 2024 Sep 25.
Tics are the hallmark of Tourette syndrome (TS) and chronic tic disorders (CTD). Although typically involving the face, especially at onset, tics may involve any muscle under voluntary control, including axial muscles of the neck (causing head movements), shoulders and trunk (thorax and abdomen). We aimed to characterize these tics and provide a clinical frame for their associations and complications.
We reviewed video recordings and clinical history of 196 patients with TS or CTD according to DSM-5.
Any axial tic was identified in 75% of patients. Tic distribution were head (n = 113, 57.6%), shoulder (n = 91, 46.4%), and trunk (n = 63, 32.2%). There were no differences in sex, age at onset or at evaluation between patients with and without axial tics. The most common axial tics by anatomical distribution were head turning, bilateral synchronous shoulder elevation and trunk jerks; however, tic phenomenology was quite variable. A greater severity of tics (P = 0.018) was associated with axial tics in the multivariate regression analysis. Head/neck tics associated with simple phonic tics (P = 0.002); whereas shoulder and trunk tics associated with complex motor tics (P < 0.05) in a bivariate analysis. Neck pain, breathing interference, sleep limitation and radiculopathy, secondary to axial tics were complications observed in a proportion of these cases.
Axial tics are commonly observed in patients with TS/CTD with variable phenomenology. They associate with greater tic severity, phonic tics and complex motor tics. They may result in neck pain, breathing interference, sleeping problems and cervical spine injuries.
抽动是妥瑞氏症（TS）和慢性抽动障碍（CTD）的标志。虽然抽动通常涉及面部，尤其是在发病初期，但抽动可能涉及任何受自愿控制的肌肉，包括颈部的轴向肌肉（导致头部运动）、肩部和躯干（胸部和腹部）。我们旨在描述这些抽动，并为其相关性和并发症提供临床框架。
我们根据 DSM-5 回顾了 196 名 TS 或 CTD 患者的视频记录和临床病史。
75%的患者出现了任何轴向抽动。抽动分布为头部（n=113，57.6%）、肩部（n=91，46.4%）和躯干（n=63，32.2%）。有无轴向抽动的患者在性别、发病年龄或评估年龄方面没有差异。按解剖分布最常见的轴向抽动为头部转动、双侧同步肩部抬高和躯干抽搐；然而，抽动表现相当多变。在多变量回归分析中，抽动严重程度（P=0.018）与轴向抽动相关。头部/颈部抽动与单纯发音性抽动相关（P=0.002）；而肩部和躯干抽动与复杂运动性抽动相关（P<0.05）在双变量分析中。这些病例中有一定比例出现了因轴向抽动引起的颈部疼痛、呼吸干扰、睡眠受限和神经根病变等并发症。
轴向抽动在 TS/CTD 患者中较为常见，表现形式多样。它们与更严重的抽动、发音性抽动和复杂运动性抽动相关。它们可能导致颈部疼痛、呼吸干扰、睡眠问题和颈椎损伤。
