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Tic disorder — DCH MCQ

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HardDevelopmentTic disorderDCH

A 12-year-old boy has an 18-month history of recurrent blinking, brief neck extension and shoulder jerks. The movements wax and wane, are sometimes preceded by an uncomfortable urge and can be suppressed for a few seconds. He has never had involuntary throat clearing, grunting, words or other sounds. His development, school performance and neurological examination are normal. What is the most specific diagnosis?

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Correct answer: E — Persistent motor tic disorder

The most specific diagnosis is persistent motor tic disorder. Blinking, neck extension and shoulder jerks are rapid, recurrent, non-rhythmic motor tics; the premonitory urge, brief suppressibility and waxing and waning course support tic phenomenology. Motor tics lasting more than one year without any vocal tic meet the definition of persistent motor tic disorder. Provisional tic disorder lasts no more than 12 months, while Tourette syndrome requires multiple motor tics and at least one vocal tic. Motor stereotypies are generally more patterned or rhythmic and are not typically associated with a premonitory urge followed by relief. Myoclonic epileptic jerks are not voluntarily suppressible and would require an epilepsy-focused assessment. The normal development and neurological examination support a primary tic disorder.

Reference: NICE. Digital therapy for chronic tic disorders and Tourette syndrome: final protocol, section 1.4 Clinical condition of interest. 22 January 2024. https://www.nice.org.uk/guidance/gid-hte10056/documents/final-protocol-2