A group of experts gathered by the Tourette Association of America \citep{Malaty2022} summarized their recommendations regarding the diagnosis of FTB. In line with previous reports, they have mentioned some clues helpful to establish this diagnosis, but at the same time point out that it cannot be based on the presence of one single characteristic.
Frey and colleagues wrote a thoughtful article on the role of social media and its potential role in the rise of FTLB in adolescents, underlining the need to educate patients on how to wisely access medical information (spoiler alert: it's not TikTok !)\citep{Frey2022a}.
Epidemiology
Several studies have addressed the prevalence and incidence of Tourette syndrome and chronic tic disorders. A systematic review and meta-analysis showed a global prevalence of TS of 0.5-0.6% and of 0.7% in the population of children and adolescents \citep{Jafari2022}.\citet{Tinker2022}, from the CDC, estimates that "350,000–450,000 U.S. children and adults have Tourette syndrome," while about a million have other chronic tic disorders.
In Asia, the National Taiwan Insurance Research Database was used to estimate incidence and prevalence of TS and chronic tic disorders from 2007-2015 \citep{Chou2022}. An increase in annual incidence rates was seen during this period in childhood and adolescence, and a decrease in adulthood. Furthermore, an increase in prevalence of TS and chronic tic disorders was seen.
In China, prevalence of tic disorders in school students between 6 and 16 years was shown to be 1.37% \citep{Yan2022}. There was seen a high comorbidity between TS and OCD.
Using 2016-2017 National Survey of Children´s Health data on children and adolescents between 6 and 17 years, parents reported that 0.3% of the children ever had been diagnosed with TS \citep{Charania2022}.
Comorbidities
\citet{Araújo2022} examined the role of ADHD and OCD in tic severity during the COVID-19 pandemic in Brazilian and Portuguese patients with TS and found that approximately half of the patients experienced worsening of tic severity and they suggest patients with comorbidity might more susceptible to the effects of the pandemic.
Food difficulties, among others greater food responsiveness and emotional overeating, were shown to be more common in children with TS than previously reported \citep{Smith2022a}.
The experience of tic-related pain and use of pain management was assessed in an online survey answered by 188 adults with self-reported tics \citep{Taylor2022}. Tic-related pain was shown to have a significant physical and psychological impact and important to be addressed in the long-term managament of tic disorders. Similar study was conducted in Poland \citep{Ma_ek_2022}, but this time it was carried out in pediatric population. The authors included 40 children with GTS and 57 parents of children with GTS, as they wanted to collect information about perspective of children and parents on this topic. For assessment of tics the authors used the YGTSS, while pain severity, localization and coping stategies were assessed with the Pediatric Pain Questionnaire, and Pediatric Pain Coping Inventory which was administered both to children and parents. Pain was reported by 60% of children with GTS and 72% of parents confirmed that their children can suffer from pain. The most common localizations of pain were cervical region, throat, shoulder, ocular region and joints. Contrary to expected, no correlation has been found between tic severity and pain. Consistency between the declarations of children and their parents in coping with pain was observed.
Ricketts et al. \citep{Ricketts2022a} published an important article about sleep disorders and the use of sleep medication, nightime tics and pattern of sleep in patients with tics.In this study 125 adults with tics were included. The participants filled out an internet survey in which they rated sleep history, sleep chronotype as well as the severity of tics and psychiatric comorbidities. The most frequently reported sleep-related disorders in population of patients with tic disorders were bruxism, insomnia, tic-related difficulty falling asleep. Sleep problems correlated with impairment, obsessisive compulsive symptoms as well as emotional regulation problems. Interestingly enough, eveningness related to tic severity. Therefore, the authors concluded that interventions to advance chronotype may help with tic improvement. The same group of authors examined another aspect of sleep disorders in the group of patients with tics \citep{Ricketts2022b}. In this study 114 children with TS were included and the authors compared those who have sleep disorders (n=32) with those who have no problems with sleep (n=82). Children with TS and sleep disorder were from households with lower parental education and at the higher risk of poverty. They also were more frequently diagnosed with comorbidities such as OCD, ODD, ADHD and autism and were prescribed more frequently anti-tic medication. In line with these findings, children with TS and sleep disorder had more severe tics, tic-related impairment and more severe ADHD symptoms.
A case-control study including 271 children with tic disorder and 271 controls revealed that children with tic disorders had increased risks for sleep disturbances as measured with Children´s Sleep Habits Questionnaire \citep{Mi2022}. Sleep disturbances included among others bed time resistance, sleep onset delay, sleep anxiety, night waking, and daytime sleepiness. The presence of comorbid ADHD increased the risk for sleep disturbances.
Nail biting (onychophagia) is very common in unselected children, but has also been included in descriptions of complex tics. A report from Taiwan examines prevalence of nail biting in over 2000 children, including 765 with a primary tic disorder, finding that nail biting is very common in TS (56.6%) and provisional tic disorder (27.4%)—much more common than in controls (15.0%)—and begins prior to onset of definite tics \citep{Hsueh2022}.
\citep{Cui_2022a} reported about emotional and behavioral profile of children with GTS in China and compare this profile with sex-matched health controls, ADHD, OCD and depression groups. To assess for behavioral and emotional problems in all groups the Child Behavior Checklist (CBCL) was implemented. No association between the eight factors of the CBCL and motor tics, vocal tics or tic severity assessed by the YGTSS was found. Nevertheless, there was a positive association between the impairment scale of the YGTSS and thought problems as well as rule-breaking behavior as assessed by the YGTSS. Contrary to expected, children with GTS showed similar profile of CBCL to the children with depression, but not ADHD and OCD.
\citep{Tessier2022} compared design fluency profile of children with GTS with matched healthy controls. As a result, they have shown that children with GTS do not show general executive dysfunction in comparison to their peers.