Pediatric Movement Disorders - Tics

Workup

In the absence of other neurologic findings, tics, compulsions, and habits usually require no further diagnostic workup. Symptoms are expected to wax and wane with time. As long as there are no cognitive delays, deterioration, and other findings on the neurological examination, the likelihood of another disorder is not significantly increased. A family history of tics or obsessive-compulsive behavior is helpful in confirming the diagnosis; however, a positive family history is not essential to the diagnosis. If another neurological symptom is present, the workup is guided by that symptom, with the presence of tics suggesting the possible involvement of the basal ganglia.

If akathisia is present, it is important to determine whether it may be caused by other medications that the child is taking or has recently taken. It is also important to be aware of signs of an anxiety disorder and to closely observe to be sure that symptoms do not actually represent a form of chorea. In adults, restless legs syndrome (RLS) and periodic limb movements of sleep (PLMS) are associated with Parkinson's disease; however, this may not be true for children. Nevertheless, if other neurological symptoms, such as tremor, rigidity, or bradykinesia are present, a search for the causes of parkinsonism is warranted.