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Child's Nervous System

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01-02-2013 | Case Report

Cervical spondylotic myelopathy caused by violent motor tics in a child with Tourette syndrome

Authors: Da-Young Ko, Seung-Ki Kim, Jong-Hee Chae, Kyu-Chang Wang, Ji Hoon Phi

Published in: Child's Nervous System | Issue 2/2013

Abstract

Introduction

We report a case of a 9-year-old boy with Tourette syndrome (TS) who developed progressive quadriparesis that was more severe in the upper extremities.

Case report

He had experienced frequent and violent motor tics consisting of hyperflexion and hyperextension for years. Magnetic resonance imaging (MRI) revealed a focal high-signal intensity cord lesion and adjacent cervical spondylotic changes. Initially, the patient was observed for several months because of diagnostic uncertainty; his neurological status had improved and later worsened again. Anterior cervical discectomy of C3–4 and fusion immediately followed by posterior fixation were performed. After surgery, the neck collar was applied for 6 months. His neurological signs and symptoms improved dramatically. TS with violent neck motion may cause cervical spondylotic myelopathy at an early age.

Conclusions

The optimal management is still unclear and attempts to control tics should be paramount. Circumferential fusion with neck bracing represents a viable treatment option.

Bloch M, Leckman J (2009) Clinical course of Tourette syndrome. J Psychosom Res 67:497–501PubMedCrossRef

Cheung M-YC, Shahed J, Jankovic J (2007) Malignant Tourette syndrome. Mov Disord 22:1743–1750PubMedCrossRef

Krauss J, Jankovic J (1996) Severe motor tics causing cervical myelopathy in Tourette’s syndrome. Mov Disord 11:563–566PubMedCrossRef

Muroi A, Matsumura A, Asakawa H, Enomoto T, Iwasaki N, Nose T (2002) Myelopathy caused by tics in an adolescent, associated with T2 signal intensity changes of the spinal cord. Childs Nerv Syst 18:191–194PubMedCrossRef

Scotti G, Gerevini S (2001) Diagnosis and differential diagnosis of acute transverse myelopathy: the role of neuroradiological investigations and review of the literature. Neurol Sci 22:S69–S73PubMedCrossRef

GdlT G (1885) Etude sur une affection nerveuse caracterisee par de l’incoordination motrice accompagnee d’echolalie et de copralalie. Arch Neurol 19:158–200

Cath D, Hedderly T, Ludolph A, Stern J, Murphy T, Hartmann A, Czernecki V, Robertson MM, Martino D, Munchau A, Rizzo R (2011) European clinical guidelines for Tourette syndrome and other tic disorders. Part I: assessment. Eur Child Adolesc Psychiatry 20:155–171PubMedCrossRef

Leckman J, Zhang H, Vitale A, Lahnin F, Lynch K, Bondi C, Kim YS, Peterson BS (1998) Course of tic severity in Tourette syndrome: the first two decades. Pediatrics 102:14PubMedCrossRef

Brill C, Hartz W, Mancall E (1981) Cervical disc herniation in the Gilles de la Tourette syndrome. Ann Neurol 9:311PubMedCrossRef

10.

Goetz CG, Klawans HL (1980) Gilles de la Tourette syndrome and compressive neuropathies. Ann Neurol 8:453PubMedCrossRef

11.

Nomura T, Kira J, Yoshimura T, Goto I, Hasuo K (1989) Flexion myelopathy due to tic of neck. Rinsho Shinkeigaku 29:177–179PubMed

12.

Adler C, Zimmerman R, Lyons M, Simeone F, Brin M (1996) Perioperative use of botulinum toxin for movement disorder-induced cervical spine disease. Mov Disord 11:79–81PubMedCrossRef

13.

Dobbs M, Berger J (2003) Cervical myelopathy secondary to violent tics of Tourette’s syndrome. Neurology 60:1862–1863PubMedCrossRef

14.

Lin J, Wang H, Wong M, Wu C, Lin K (2007) Tourette’s syndrome with cervical disc herniation. Brain Dev 29:61–63PubMedCrossRef

15.

Aguirregomozcorta M, Pagonabarraga J, Diaz-Manera J, Pascual-Sedano B, Gironell A, Kulisevsky J (2008) Efficacy of botulinum toxin in severe Tourette syndrome with dystonic tics involving the neck. Parkinsonism Relat Disord 14:443–445PubMedCrossRef

16.

Isaacs J, Adams M, Lees A (2010) Noncompressive myelopathy associated with violent axial tics of tourette syndrome. Neurology 74:697PubMedCrossRef

17.

Baron E, Young W (2007) Cervical spondylotic myelopathy: a brief review of its pathophysiology, clinical course, and diagnosis. Neurosurgery 60:S1-35–S31-41CrossRef

18.

Eddy CM, Rickards HE, Cavanna AE (2011) Treatment strategies for tics in Tourette syndrome. Ther Adv Neurol Disord 4:25–45PubMedCrossRef

19.

Epstein N (1999) Circumferential cervical surgery for spondylostenosis with kyphosis in two patients with athetoid cerebral palsy. Surg Neurol 52:339–344PubMedCrossRef

20.

Tsirikos A, Chang W, Dabney K, Miller F (2003) Comparison of one-stage versus two-stage anteroposterior spinal fusion in pediatric patients with cerebral palsy and neuromuscular scoliosis. Spine (Phila Pa 1976) 28:1300–1305

Title: Cervical spondylotic myelopathy caused by violent motor tics in a child with Tourette syndrome
Authors: Da-Young Ko
Seung-Ki Kim
Jong-Hee Chae
Kyu-Chang Wang
Ji Hoon Phi
Publication date: 01-02-2013
Publisher: Springer-Verlag
Published in: Child's Nervous System / Issue 2/2013
Print ISSN: 0256-7040
Electronic ISSN: 1433-0350
DOI: https://doi.org/10.1007/s00381-012-1939-x

At a glance: The ONWARDS insulin icodec trials

Springer Medicine

Cervical spondylotic myelopathy caused by violent motor tics in a child with Tourette syndrome

Abstract

Introduction

Case report

Conclusions

At a glance: The ONWARDS insulin icodec trials

Springer Medicine

Abstract

Introduction

Case report

Conclusions

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