Childhood trauma, life events and clinical presentation in functional tic-like behavior and Tourette syndrome: preliminary data from a non-interventional study

Background

:Motor and vocal tics are the key symptoms in Gilles-de-la-Tourette syndrome (GTS), a hereditary, neurodevelopmental disorder with an early onset. In contrast to organic tics (OT) in GTS, functional tic-like behaviors (FTLB) are classified as functional movement disorders (FMD). Psychosocial stress, precipitating events and trauma as potential signs of altered emotion processing have been implicated in the genesis of functional motor disorders in general. The impact of stressful life events on the onset of OT in GTS is less known. The main goal of this study is to identify differences between GTS and functional tic-like behavior to improve clinical discrimination and consecutively adequate treatment. We expect both conditions to differ in clinical presentation, comorbidities and preceding psychosocial stressors.

Methods

We conduct a cross-sectional, mono-center, non-interventional clinical study at the specialized outpatient clinic for Tourette and tic disorders at the Department of Psychiatry and Psychotherapy in collaboration with the outpatient clinic for functional neurological disorders at the Department of Neurology. We expect to include 40 participants above 18 years with a primary diagnosis of either GTS or FTLB (20 patients per group) and present preliminary results in this abstract. Patients are allocated to study groups according to the clinical diagnosis assigned in either of both outpatient clinics. Diagnostics is based on the ICD-10 classification criteria and the criteria for the clinical diagnosis for FTLB published recently [1]. Participants undergo a single study visit for a clinical interview and the following questionnaires: Yale Global Tic Severity Scale (YGTTS), Montgomery Åsberg depression rating scale (MADRS), questionnaire on autoaggressive behavior in GTS, childhood trauma questionnaire – short form (CTQ), recent life events questionnaire (LEQ). Due to the currently small sample size preliminary results are presented descriptively. Fisher’s exact test was applied to analyze outcome parameters, when applicable.

Results

Until May 2026, we included 16 out of the intended 40 patients (10 GTS, 6 FTLB) in the ongoing clinical study with a median age of 27.5 years (IQR 17). Gender distribution differed significantly between both diagnoses with 8 male GTS (2 female GTS patient) and 5 female FTLB patients (1 male FTLB patient) (p=0.013). Comorbidities did not differ considerably between both tic disorders. Type of tic-onset (p<0.001), age at tic-onset (GTS: 8±2.45 vs. FTLB 18.17±7.25) and rostrocaudal progression (p<0.001) showed a significant difference between FTLB and OT. We investigated the CTQ (GTS: 53.22±8.93 vs. FTLB: 63.17±13.24), YGTSS (GTS: 57.2±14.13 vs. FTLB: 53.67±17.01), MADRS (GTS: 10.78±6.37 vs. FTLB: 14.5±10.9), the score on autoaggressive behavior (GTS: 5.5 (IQR 10) vs. FTLB: 11 (IQR 12)) and the negative life events before tic onset (GTS: -0.5 (IQR 4) vs. FTLB: -9 (IQR 6)) between both tic disorders. Looking in detail at the symptomatic presentation (complex tics, blocking tics, tic bursts), no remarkable difference between FTLB and GTS was observed.

Conclusions

In this preliminary subset of study patients, childhood trauma and (negative) life events before tic-onset provide indications of an association with the occurrence of FTLB. Considering the preliminary nature of the data, the results should be interpreted with caution.

References

1. Pringsheim T, Ganos C, Nilles C, Cavanna AE, Gilbert DL, Greenberg E, et al. European Society for the Study of Tourette Syndrome 2022 criteria for clinical diagnosis of functional tic-like behaviours: International consensus from experts in tic disorders. Eur J Neurol. 2023; 30(4): 902-10