Talk:Tourettism

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[edit] Copied from MCOTW:

I'm not sure if:

• I've categorized each thing correctly,
• the categories I used make sense, or
• the article can be arranged in a way that is not listy, rather written prose.

Thanks, Sandy 19:47, 4 July 2006 (UTC)

Hi Sandy,

I just had a quick glance at Tourettism, and the bit I'd like to focus on is the Introduction. Specifically, where it says: "Although Tourette syndrome is the most frequent cause of tics, other sporadic, genetic, and neurodegenerative disorders may also exhibit tics. These cases are referred to as "tourettism", secondary causes of tics, or identified as "sporadic" TS."

• I believe that there's a bit of a mix-up in this assertion. "Sporadic TS" is Tourette Syndrome, not tourettism. "Sporadic" simply means that there is no apparent hereditary basis for the syndrome (ie, it's apparently not inherited) - basically, it means that it's the first and only known case of TS in a given family.

Hmmm, it looks like I need to tighten up the terminology: the TS literature seems to use the terms interchangeably. For example, from Jankovic, "A variety of sporadic, genetic, and neurodegenerative disorders may also exhibit tics. We review all cases of tics associated with other disorders (sometimes termed "tourettism") that have presented to our clinic, in a belief that a study of secondary cases of tics may provide insight into the pathogenesis of primary tics and TS."

• Another thing I would mention is that "tourettism" and "secondary causes of tics" are not the same thing. The "secondary causes of tics" are the diseases mentioned (neurodegenarative, toxic, and so forth). "Tourettism" is "the presence of touretteish tics caused by secondary causes of tics, and not by TS".

I knew I needed help on this one :-)

• I would dispute the statement that TS is the most common cause of tics. TS is relatively rare. Tics are very frequent. I don't have any references with me at the moment. Can anyone give us hard numbers?

Sure, I can help.

Tourette syndrome has historically been described as a rare disorder, with about 5 to 10 people in 10,000 having the condition. (PMID 11077021) However, multiple studies published since 2000 demonstrate that the prevalence is much higher than previously thought, and that Tourette syndrome can no longer be considered rare. Contemporary prevalence estimates range from 1 to 3 per 1,000 (PMID 11530433) to 10 per 1,000. (PMID 10802971)

"Careful epidemiologic studies now estimate the prevalence of TS to be substantially higher than previously thought." (Walkup JT, Mink JW, Hollenback PJ, (eds). Advances in Neurology, Vol. 99, Tourette Syndrome. Lippincott, Williams & Wilkins, Philadelphia, PA, 2006, p. xvi.) (PMID 11806685 PMID 12729145 PMID 15555352 PMID 12842225 PMID 12685307 and PMID 14980369)

A large, community-based study suggested that over 19% of school-age children have tics, with almost 4% of children in regular education fulfilling the diagnostic criteria for Tourette Syndrome. The children with tic disorders in that study were usually undiagnosed. PMID 11673576

As many as 1 in 100 people may experience some form of tic disorder, which includes transient tics, chronic tics, or Tourette Syndrome. (NIH [1])

In summary, from the TSA Medical Advisory Board Letter of 2004, "Integrating these new data with the discussion from the most recent review (Scahill et al, 2004) suggests that the prevalence of TS can be revised to 1 to 10 per 1,000."

Within TS research, and on the TSA Medical Advisory Board, Jankovic has always been the go-to guy on tourettism and secondary causes of tics. He has published several papers with Mejia, who I believe is the Brazilian. Jankovic J, Mejia NI. Tics associated with other disorders. Adv Neurol. 2006;99:61-8. PMID 16536352 "Although TS is the most common cause of tics, there are many other etiologies of tics and TS-like features (tourettism)."

• I might also reformulate some expressions, so that it doesn't seem to borrow the Brazilian article in 'References'.

I would suggest something along these lines:

" "Tourettism" refers to the presence of Tourette-like behaviour in the absence of Tourette Syndrome. This behaviour is the result of other diseases or conditions, which are known as its 'secondary cause'. "

(Do you want to move this discussion to Talk:Tourettism?) MIP 22:11, 22 July 2006 (UTC)

Yes, that would really help. I interspersed the three terms incorrectly. I've been trying to attract someone to help me finish up for some time, and I *really* appreciate the help !! Sandy 01:23, 23 July 2006 (UTC)

Hi again, Sandy.

Thanks for the epidemiological information.

I would still tighten the information on two details:

• The Introduction now reads ' "Tourettism" refers to the presence of tics in the absence of Tourette Syndrome" '. I would still suggest correcting this to 'Tourette-like tics', or 'Tourette-like behaviour' or even 'Tourette-like symptoms'. We don't use "Tourettism" to refer to any tic'ing behaviour - we only use it when the tics are reminiscent of the ones we find in real TS.

For example, a child with the habit of scrunching their nose doesn't have "Tourettism", they have "a tic".

Got it. I didn't want to stray too far from the referenced text, lest it verge on original research, but we can fix this. Sandy 15:38, 23 July 2006 (UTC)

• Regarding the numbers you found, I think we could still adjust the "most common cause" citation. I might change it to "most common cause of tic disorder".

The quote states "over 19% of school-age children have tics, with almost 4% of children in regular education fulfilling the diagnostic criteria for Tourette Syndrome". That means that only 1 out of 5 children with a tic has TS. However, most of these tics are simple, run-of-the-mill tics. (Like our nose-scrunching kid.)

When you consider tic disorder, however, then TS seems to be the most common cause.

What do you think? MIP 15:11, 23 July 2006 (UTC)

The same thing came to me in the middle of the night :-) There is a logical fallacy in the statement by Jankovic: clearly there is a higher prevalence of transient and chronic tic disorder, so it's not possible for TS to be "the most common cause". This seems to be an example of less than careful language (just like this one), and perhaps what he meant was "the most common cause relative to the other secondary causes" (but not including other tic disorders). I'm not sure how I can fix a referenced statement without engaging in original research, since I now have to guess why Jankovic said that. You were completely correct in picking this up, but I'm not sure how to fix it. If I replace it with a statement similar to yours, how do I avoid original research? Sandy 15:38, 23 July 2006 (UTC)

I'll try to drop by the Faculty Library at our local Hospital, tomorrow, and see if I can find any references which are more specific than the current ones. MIP 20:18, 23 July 2006 (UTC)

Thanks, MIP. Don't hold your breath, though ... my impression is that Jankovic is the most-published researcher on secondary causes of tics ... I'll see if I can fudge the wording for now. Thanks again! Sandy 21:35, 23 July 2006 (UTC)

[edit] More quotes, to help resolve problem

I'm scanning the Adv. Neur text for quotes that may help me avoid the original research problem. This helps sort out my problem with terminology:

"This review is organized according to tic mimickers (phenomenoloyg) and tics secondary to other causes (etiology), sometimes referred to as tourettism. " (Then, the article is divided in two: Tic Mimickers, and Causes of Tics.)

Does that mean this entire article is listing two different things, or can the tic mimickers (dystonias, myoclonus, and chorea) be included in a tourettism article? This is where my lack of medical background gets me into deep water. I guess I need to delete the tic mimickers from the list, or describe them as tic mimickers in the text?

Under Causes of Tics

"Although TS is the most common cause of tics, there are many other etiologies of tics and TS-like features (tourettism). To better understand the spectrum of causes of tourettism, ..."

He also lists psychogenic tics in Causes: should they be added?

I can't find any wording that helps me avoid re-phrasing his statement about "most common cause", and still need to figure a way around engaging in original research. Sandy 15:59, 23 July 2006 (UTC)

[edit] Antipsychotics as a cause for tourettism - why the TD reference should not be removed

"Tardive tourettism or tardive akathesia is not the same as tardive dyskinesia"? Sorry, but I'm going to have to disagree with that - according to http://www.emedicine.com/NEURO/topic362.htm, "tardive dyskinesia" encompasses several speficic types, including 'tardive tics' and 'tardive tourettism'. At worst, these could be considered variants of TD, but there's no doubt anywhere I could find that they aren't very closely related. Perhaps the TD reference should be changed to just tardive tourettism, but why remove the entire comment? I've readded the TD reference, with a bit more detail and reworded - the 'often' there originally was misleading as it stood. - Pacula 12:46, 3 November 2006 (UTC)