2023 American Academy of Neurology Abstract Website

Objective:

To add to the limited existing reports on the demographics, clinical history, phenomenology, and treatment response of patients with functional tic-like behavior (FTLB), with the addition of gender-identity associations.

Background:

Reported numbers of young adults presenting with FTLB has increased recently, partly related to the COVID-19 pandemic and social media. Patients with FTLB are predominantly young females with rapid symptom onset. Gender identity has not been assessed. Response to therapy and medications has been variable.

Design/Methods:

This single-center case series included patients that presented to the Northwestern University Parkinson’s Disease and Movement Disorders Center with FTLB between February and September 2021.

Results:

The mean age of onset and diagnosis were 22 and 22.4 years old (n=8), respectively. All patients were female sex at birth, and 5 (62.5%) identified their gender as non-binary. Three patients (37.5%) had comorbid functional neurological disorders. The majority (n=7, 87.5%) had depression and anxiety, 2 (25%) had ADHD, and 2 (25%) had OCD. Three-quarters (n=6, 75%) of patients were on psychiatric medications. Half (n=4, 50%) of the patients used substances, including alcohol, nicotine, marijuana, or drugs. One patient had isolated motor tics and the rest (n=7, 87.5%) had complex motor and verbal tic-like movements with frequent self-injurious behavior. All patients were recommended to start comprehensive behavioral intervention for tics with habit reversal therapy (CBIT/HRT), guanfacine, and gingko biloba. One year follow up was available for 5 patients. Tics improved in 2 patients (25%) following CBIT/HRT and in 1 patient (12.5%) using guanfacine and gingko biloba. Tics were stable in 2 patients (25%) without intervention.

Conclusions:

All patients were young adults of female sex, with abrupt onset of FTLB during the COVID-19 pandemic. Interestingly, the majority identified their gender as non-binary. Several patients experienced tic reduction after using CBIT/HRT, alpha-agonists, and/or gingko biloba, suggesting that these may be beneficial treatments.