Rapid Onset Functional Tic‐Like Behaviors in Young Females During the COVID ‐19 Pandemic

Abstract

BackgroundSince the beginning of the COVID-19 pandemic, our colleagues working at eight different Tourette syndrome (TS) clinics globally have witnessed a parallel pandemic of young people aged 12 to 25 years (almost exclusively girls and women) presenting with the rapid onset of complex motor and vocal tic-like behaviors.1 In most cases, these behavioral patterns are consistent with a functional neurological disorder.There have been striking commonalities in the phenomenology of these ticlike behaviors observed across our centers in Canada, the United States, the United Kingdom, Germany, and Australia.The aim of this viewpoint is to help clinicians recognize patients with this disorder and distinguish them from patients with TS.We begin by describing the clinical phenomenology and demographic characteristics of youth with rapid onset functional tic-like behaviors (FTLBs) using illustrative data from the Tic Disorders Clinical Registry at the Calgary Tourette and Pediatric Movement Disorders Clinic.We then discuss our shared experiences across our eight centers and provide preliminary viewpoints on the pathophysiology and treatment of this complex disorder. The Calgary Tic Disorders Clinical RegistryThis registry enrolls participants at their first clinic visit into a prospective cohort study assessing long-term outcomes in youth with tics.The registry is approved by the Calgary Health Research Ethics Board, and all participants provide informed consent.Baseline data elements include age, sex, age at tic onset, current medication use, tic disorder diagnosis, Yale Global Tic Severity Scale (YGTSS) score, presence of comorbid attention deficit hyperactivity disorder (ADHD) and symptom severity on the Conners 3, obsessivecompulsive disorder and symptom severity on the Children's Yale Brown Obsessive Compulsive Scale (CYBOCS), anxiety disorder (including generalized anxiety disorder, social anxiety disorder, or panic disorder) and symptom severity on the Multidimensional Anxiety Scale for Children version 2 (MASC2), major -----------------------------------

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