Differences

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--- tics [2026/08/06 20:50] – Scott Larson
+++ tics [2026/08/06 20:54] (current) – Scott Larson
@@ Line 1: / Line 1: @@
 ====== Tics ======
-FIXME
   * Sudden, rapid, recurrent, nonrhythmic motor movement or vocalization that is experienced as involuntary but can often be temporarily suppressed.
   * Typical onset between ages **4–6 years** and are preceded by a premonitory urge
@@ Line 39: / Line 37: @@
 ===Pharmacotherapy (when behavioral therapy is insufficient or unavailable)===
-- **First-line: Alpha-2 agonists** — **guanfacine** and **clonidine** have moderate evidence and a favorable side-effect profile (sedation, hypotension); preferred as initial medication in children. Particularly useful when comorbid **ADHD** is present.
+  * **First-line: Alpha-2 agonists** — **guanfacine** and **clonidine** have moderate evidence and a favorable side-effect profile (sedation, hypotension); preferred as initial medication in children. Particularly useful when comorbid **ADHD** is present.
-- **Second-line: Atypical antipsychotics** — **aripiprazole**, **risperidone**, and tiapride have evidence for tic reduction but carry risks of metabolic syndrome and tardive dyskinesia.
+  * **Second-line: Atypical antipsychotics** — **aripiprazole**, **risperidone**, and tiapride have evidence for tic reduction but carry risks of metabolic syndrome and tardive dyskinesia.
-- **Third-line: Typical antipsychotics** — haloperidol and pimozide are effective but reserved for refractory cases due to significant adverse effects (extrapyramidal symptoms, QT prolongation).
+  * **Third-line: Typical antipsychotics** — haloperidol and pimozide are effective but reserved for refractory cases due to significant adverse effects (extrapyramidal symptoms, QT prolongation).
 **Comorbidities** are common and should be assessed: **ADHD** (alpha-2 agonists can treat both), **OCD** (SSRIs or CBT with exposure/response prevention), anxiety, and learning difficulties.
@@ Line 51: / Line 49: @@
   - [[https://pubmed.ncbi.nlm.nih.gov/31061209/|Comprehensive Systematic Review Summary: Treatment of Tics in People With Tourette Syndrome and Chronic Tic Disorders. Pringsheim T, Holler-Managan Y, Okun MS, et al. Neurology. 2019;92(19):907-915]]
   - [[https://publications.aap.org/pediatrics/article/155/3/e2024070334/200384/Pediatric-Acute-Onset-Neuropsychiatric-Syndrome?autologincheck=redirected|Pediatric Acute-Onset Neuropsychiatric Syndrome (PANS): Clinical Report. Pediatrics. 2025;155(3):e2024070334]]
-  - [[https://pubmed.ncbi.nlm.nih.gov/31061208/|Practice Guideline Recommendations Summary: Treatment of Tics in People With Tourette Syndrome and Chronic Tic Disorders. Pringsheim T, Okun MS, Müller-Vahl K, et al. Neurology. 2019;92(19):896-906]]
+  - {{::practice_guideline_recommendations_summary_treatment_of_tics_in_people_with_tourette_syndrome_and_chronic_tic_disorders.pdf |Practice Guideline Recommendations Summary: Treatment of Tics in People With Tourette Syndrome and Chronic Tic Disorders. Pringsheim T, Okun MS, Müller-Vahl K, et al. Neurology. 2019;92(19):896-906}}
   - [[https://pubmed.ncbi.nlm.nih.gov/36354027/|Tourette Syndrome: Clinical Features, Pathophysiology, and Treatment. Johnson KA, Worbe Y, Foote KD, et al. The Lancet. Neurology. 2023;22(2):147-158]]
   - [[https://pubmed.ncbi.nlm.nih.gov/31061208/|Practice Guideline Recommendations Summary: Treatment of Tics in People With Tourette Syndrome and Chronic Tic Disorders. Pringsheim T, Okun MS, Müller-Vahl K, et al. Neurology. 2019;92(19):896-906]]
   - [[https://acamh.onlinelibrary.wiley.com/doi/abs/10.1111/jcpp.12556|Practitioner Review: Treatments for Tourette Syndrome in Children and Young People - A Systematic Review. Whittington C, Pennant M, Kendall T, et al. Journal of Child Psychology and Psychiatry, and Allied Disciplines. 2016;57(9):988-1004]]
   - [[https://pubmed.ncbi.nlm.nih.gov/27527544/|Child Neurology: Diagnosis and Treatment of Tourette Syndrome. Hirschtritt ME, Dy ME, Yang KG, Scharf JM. Neurology. 2016;87(7):e65-7]]
-  - {{::practice_guideline_recommendations_summary_treatment_of_tics_in_people_with_tourette_syndrome_and_chronic_tic_disorders.pdf |Practice guideline recommendations summary: Treatment of tics in people with Tourette Syndrome and chronic tic disorders}}