Download PDF
Journal of Pediatric Neurology 2021; 19(05): 339-342
DOI: 10.1055/s-0040-1718696
Case Report

Cervical Myelopathy as a Complication of Untreated Motor Tics: A Cautionary Tale

Mariam Hull
1   Section of Pediatric Neurology and Developmental Neuroscience, Pediatric Movement Disorders Clinic, Blue Bird Circle Clinic for Pediatric Neurology, Texas Children's Hospital | Baylor College of Medicine, Houston, Texas, United States
,
Mered Parnes
1   Section of Pediatric Neurology and Developmental Neuroscience, Pediatric Movement Disorders Clinic, Blue Bird Circle Clinic for Pediatric Neurology, Texas Children's Hospital | Baylor College of Medicine, Houston, Texas, United States
› Author Affiliations Funding None.
› Further Information
Also available at
    Permissions and Reprints

Abstract

Tic disorders are common, affecting approximately 0.5 to 1% of children and adolescents. Treatment is required only when symptoms are bothersome or impairing to the patient, so many do not require intervention. However, on occasion tics may cause significant morbidity and are referred to as “malignant.” These malignant tics have resulted in cervical myelopathy, subdural hematoma secondary to head banging, biting of lips leading to infection of oral muscles, self-inflicted eye injuries leading to blindness, skeletal fractures, compressive neuropathies, and vertebral artery dissection. We describe a case of malignant tic disorder, with accompanying video segment, resulting in cervical myelopathy and quadriparesis in a child. We also discuss aggressive management strategies for neurologists to prevent potential lifelong disability. This case emphasizes that these malignant tics must be treated with all due haste to prevent such complications.

Keywords

Tourette syndrome - malignant tics - motor tics - complications of motor tics - traumatic cervical myelopathy


Publication History

Received: 31 August 2020

Accepted: 11 September 2020

Article published online:
26 October 2020

© 2020. Thieme. All rights reserved.

Georg Thieme Verlag KG
Rüdigerstraße 14, 70469 Stuttgart, Germany

 

  • References

  • 1 Robertson MM. A personal 35 year perspective on Gilles de la Tourette syndrome: prevalence, phenomenology, comorbidities, and coexistent psychopathologies. Lancet Psychiatry 2015; 2 (01) 68-87
    CrossrefPubMedSearch in Google Scholar
  • 2 Jankovic J. Treatment of tics associated with Tourette syndrome. J Neural Transm (Vienna) 2020; 127 (05) 843-850
    CrossrefPubMedSearch in Google Scholar
  • 3 Martino D, Mink JW. Tic disorders. Continuum (Minneap Minn) 2013; 19 (5 Movement Disorders) 1287-1311
    PubMedSearch in Google Scholar
  • 4 Cheung MYC, Shahed J, Jankovic J. Malignant Tourette syndrome. Mov Disord 2007; 22 (12) 1743-1750
    CrossrefPubMedSearch in Google Scholar
  • 5 Lin JJ, Wang HS, Wong MC, Wu CT, Lin KL. Tourette's syndrome with cervical disc herniation. Brain Dev 2007; 29 (02) 61-63
    CrossrefPubMedSearch in Google Scholar
  • 6 Wong AS, Massicotte EM, Fehlings MG. Surgical treatment of cervical myeloradiculopathy associated with movement disorders indications, technique, and clinical outcome. Available at: https://journals.lww.com/jspinaldisorders. Accessed 2005
    Search in Google Scholar
  • 7 Patterson AL. et al. Severe neurological complications associated with tourette syndrome. In: Pediatric Neurology. Elsevier Inc. 2016: 99-106 (61)
    Search in Google Scholar
  • 8 Krauss JK, Jankovic J. Severe motor tics causing cervical myelopathy in Tourette's syndrome. Mov Disord 1996; 11 (05) 563-566
    CrossrefPubMedSearch in Google Scholar
  • 9 Miyashita T. et al. Multiple neck operations in a patient with severe motor tics because of Tourettes syndrome: a case report. J Med Case Reports 2012 6.
    Search in Google Scholar
  • 10 Muroi A, Matsumura A, Asakawa H, Enomoto T, Iwasaki N, Nose T. Myelopathy caused by tics in an adolescent, associated with T2 signal intensity changes of the spinal cord. Childs Nerv Syst 2002; 18 (3-4): 191-194
    CrossrefPubMedSearch in Google Scholar
  • 11 Lehman LL, Gilbert DL, Leach JL, Wu SW, Standridge SM. Vertebral artery dissection leading to stroke caused by violent neck tics of Tourette syndrome. Neurology 2011; 77 (18) 1706-1708
    CrossrefPubMedSearch in Google Scholar
  • 12 Goetz CG, Klawans HL. Gilles de la Tourette syndrome and compressive neuropathies. Ann Neurol 1980; 8 (04) 453
    CrossrefPubMedSearch in Google Scholar
  • 13 Fusco C, Bertani G, Caricati G, Della Giustina E. Stress fracture of the peroneal bone secondary to a complex tic. Brain Dev 2006; 28 (01) 52-54
    CrossrefPubMedSearch in Google Scholar
  • 14 Eisenhauer GL, Woody RC. Self-mutilation and Tourette's disorder. J Child Neurol 1987; 2 (04) 265-267
    CrossrefPubMedSearch in Google Scholar
  • 15 Lim S, Rezai KA, Abrams GW, Eliott D, Mich D. Self-induced, bilateral retinal detachment in Tourette syndrome. Arch Ophthalmol 2004; 122 (06) 930-931
    CrossrefPubMedSearch in Google Scholar
  • 16 Dobbs M, Berger JR. Cervical myelopathy secondary to violent tics of Tourette's syndrome. Neurology 2003; 60 (11) 1862-1863
    CrossrefPubMedSearch in Google Scholar
  • 17 Stafford M, Cavanna AE. Prevalence and clinical correlates of self-injurious behavior in Tourette syndrome. Neurosci Biobehav Rev 2020; 113: 299-307
    CrossrefPubMedSearch in Google Scholar
  • 18 Rupniak NMJ, Jenner P, Marsden CD. Acute dystonia induced by neuroleptic drugs. Psychopharmacology (Berl) 1986; 88 (04) 403-419
    PubMedSearch in Google Scholar
  • 19 Janik P, Figura M. Tetrabenazine-induced oculogyric crisis - a rare complication in the treatment of Gilles de la Tourette syndrome. Neuropsychiatr Dis Treat 2016; 12: 497-499
    CrossrefPubMedSearch in Google Scholar
  • 20 Burke RE, Reches A, Traub MM, Ilson J, Swash M, Fahn S. Tetrabenazine induces acute dystonic reactions. Ann Neurol 1985; 17 (02) 200-202
    CrossrefPubMedSearch in Google Scholar
  • 21 Marras C, Andrews D, Sime E, Lang AE. Botulinum toxin for simple motor tics: a randomized, double-blind, controlled clinical trial. Neurology 2001; 56 (05) 605-610
    CrossrefPubMedSearch in Google Scholar
  • 22 Xu W, Zhang C, Deeb W. et al. Deep brain stimulation for Tourette's syndrome. Transl Neurodegener 2020; 9: 4
    CrossrefPubMedSearch in Google Scholar
  • 23 Huasen B, McCreary R, Evans J, Potter G, Silverdale M. Cervical myelopathy secondary to Tourette's syndrome managed by urgent deep brain stimulation. Mov Disord 2014; 29 (04) 452-453
    CrossrefPubMedSearch in Google Scholar