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Uneven focal shoe deterioration in Tourette syndrome

Authors Andrea E Cavanna, Francesco Monaco, Marco Mula, Mary M Robertson, Hugo D Critchley

Published 15 December 2006 Volume 2006:2(4) Pages 587—588


Andrea E Cavanna1,2, Francesco Monaco1, Marco Mula1, Mary M Robertson2, Hugo D Critchley3

1Department of Neurology, Amedeo Avogadro University, Novara, Italy; 2UCL Institute of Neurology, London, UK; 3Department of Psychiatry, Brighton and Sussex Medical School, Brighton, UK

A 31-year-old single man (AB) sought neuropsychiatric consultation for treatment-resistant motor and vocal tics. He described himself expressing a total of 24 different tics, mainly facial twitches (eye blinking, raising eyebrows, mouth opening, lips licking, stereotyped grimacing) and inappropriate utterances (grunting, throat clearing, sniffing), since the age of 7. There appeared to be no family history of tic disorder. He reported occasional utterance of swear words in contextually inappropriate situations (coprolalia), and the urge to copy other people’s movements (echopraxia). Other tic-associated symptoms included self-injurious behaviours and forced touching of objects. A.B. met both DSM-IV-tr and ICD-10 criteria for Tourette syndrome, and also DSM-IV-tr criteria for attention deficit hyperactivity disorder (combined type) in childhood.