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Sudden onset of tics in children
Motor and Vocal Tics
Many kids experience tics in childhood, but a new onset of tics accompanied by other behavioral or psychiatric symptoms, such as ADHD or OCD, can be due to an underlying infection-triggered autoimmune response.
Tic disorders, including Tourette’s syndrome (TS), are characterized by involuntary, abrupt, repetitive movements and/or vocal utterances. Motor tics (excessive eye blinking, eye rolls, facial grimaces, hand gestures) and vocal tics (coughing, throat clearing, spitting, grunting) can wax and wane over time. Tics, which typically surface between the ages of 4 and 6 1, often appear alongside symptoms of OCD and ADHD.
The exact cause of motor and vocal tics is unknown but genetics are believed to play a role. Certain toxins or drugs, brain trauma, alterations in neurotransmitter functioning and changes in certain regions of the brain, along with environmental factors, such as infections can also contribute to the sudden onset of tics.
Infections and sudden onset of tics in a child
Mounting evidence indicates that multiple types of infections can trigger the sudden onset of tics in a child, adolescent or adult. Researchers believe that in some people, common infections can trigger an abnormal immune response, in which antibodies mistakenly attack healthy cells in the brain. This autoimmune attack on the brain can disrupt normal neuronal cell functioning and cause inflammation in the brain, resulting in the onset of neuropsychiatric symptoms, including tics.
The concept of infections triggering motor and vocal tics is not new. In 1929, a case series was published describing three boys who developed tics following surgery for sinusitis. 3 Since then, multiple infectious agents have been linked with tic disorders.
Types of Infections that can cause a sudden onset of tics
For example, Group A strep infections can cause a sudden onset of tics in a child or adolescent who is genetically susceptible. In these cases, the child’s tics may be the result of a treatable autoimmune disorder known as Pediatric Autoimmune Neuropsychiatric Disorders Associated with Strep infections (PANDAS). In fact, researchers estimate that at least 25% of children and adolescents diagnosed with obsessive-compulsive disorder (OCD) and tic disorders, such as Tourette’s, actually have PANDAS. 4
Other types of infections can trigger a sudden onset of tics in a child. These include Borrelia burgdorferi (the bacteria causing Lyme disease), mycoplasma pneumoniae, and herpes simplex virus. 5
Neurologic or infection-induced autoimmune disorder
Making the distinction between a neurologic tic disorder and an infection-induced autoimmune disorder is important, since treatment differs for each.
In utilizing the Autoimmune Brain Panel™ (also known as the Cunningham Panel™), investigators found elevated levels of several antineuronal antibodies in patients with chronic tics and/or OCD. Elevated levels indicate that symptoms, such as tics, may be due to an infection-triggered autoimmune process. 6
The study found a “significant correlation of streptococcal-associated tics and OCD with elevated anti-D1R and anti-Lysoganglioside antineuronal antibodies in serum concomitant with higher activation of CaMKII in human neuronal cells.” 6
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Is your child struggling with treatment-resistant tics? It may be due to an autoimmune response.
Chronic tics and OCD may have underlying etiology
“Youth and young adults with chronic tics and OCD may have underlying infectious/immunologic etiology,” the authors concluded. 5
Researchers have also found that children who had multiple strep infections were at a greater risk of developing Tourette’s syndrome when compared to those who did not have repeated infections. 6
Other types of infections can trigger a sudden onset of tics in a child. Borrelia burgdorferi (the bacteria causing Lyme disease), mycoplasma pneumoniae, and herpes simplex virus are believed to play a role in the pathogenesis of tic disorders, such as Tourette’s syndrome. 7
Additionally, the enterovirus (EV) has been associated with a greater incidence of tic disorders. 8 “Our observations add to the growing body of literature implicating the immune-inflammatory process as relevant to the pathoetiology of some mental disorders,” reports Tsai and colleagues. 8
Researchers have also found that children who had multiple strep infections were at a greater risk of developing Tourette’s syndrome when compared to those who did not have repeated infections. 6
Other types of infections can trigger a sudden onset of tics in a child. Borrelia burgdorferi (the bacteria causing Lyme disease), mycoplasma pneumoniae, and herpes simplex virus are believed to play a role in the pathogenesis of tic disorders, such as Tourette’s syndrome. 7
Additionally, the enterovirus (EV) has been associated with a greater incidence of tic disorders. 8 “Our observations add to the growing body of literature implicating the immune-inflammatory process as relevant to the pathoetiology of some mental disorders,” reports Tsai and colleagues. 8
References
- American Psychiatric Association. Diagnostic and Statistical Manual of Mental Disorders fifth edition. Washington (DC): American Psychiatric Association; 2013.
- Hornig M, Lipkin WI. Immune-mediated animal models of Tourette syndrome. Neurosci Biobehav Rev. 2013;37(6):1120–1138. doi:10.1016/j.neubiorev.2013.01.007 https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4054816/
- Selling L. The role of infection in the etiology of tics. Arch Neurol Psychiatry. 1929;22:1163–1171.
- Westley, Erica. From Throat to Mind. Strep today, anxiety later? Scientific American. Jan. 1, 2010. https://www.scientificamerican.com/article/from-throat-to-mind
- Krause DL, Müller N. The Relationship between Tourette’s Syndrome and Infections. Open Neurol J. 2012;6:124–128. doi:10.2174/1874205X01206010124 https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3514747/
- Cox CJ, Zuccolo AJ, Edwards EV, et al. Antineuronal antibodies in a heterogeneous group of youth and young adults with tics and obsessive-compulsive disorder. J Child Adolesc Psychopharmacol. 2015;25(1):76–85. doi:10.1089/cap.2014.0048 https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4340634/
- Krause DL, Müller N. The Relationship between Tourette’s Syndrome and Infections. Open Neurol J. 2012;6:124–128. doi:10.2174/1874205X01206010124 https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3514747/
- Tsai CS, Yang YH, Huang KY, Lee Y, McIntyre RS, Chen VC. Association of Tic Disorders and Enterovirus Infection: A Nationwide Population-Based Study. Medicine (Baltimore). 2016;95(15):e3347. doi:10.1097/MD.0000000000003347 https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4839835/