Tik Bozuklukları ve Stereotipik Hareket Bozukluğunun Ayırıcı Tanısında Motor Beceriler ve Silik Nörolojik Bulguların Değerlendirilmesi
Akbaş Aliyev, Ecem Selin
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Tics are quick, rapid, recurrent, non-rhythmic, brief movements or vocalizations that have a waxing and waning course. Stereotypic movements are repetitive, involuntary, rhythmic, coordinated, patterned, and purposeless behaviors. Tics and stereotypies are similar and can be confused since they contain motor or vocal components, and one type of motor movement is repeated similarly. Tic disorders and stereotypical movement disorders often accompany each other. The Cortico-Striato-Talamo-Cortical (CSTC) pathway, which is responsible for motor functions, has been shown to play a role in the pathophysiology of both movement disorders. There seems to be insufficient information on how soft neurological signs (SNS) and motor skills can play a role in the differential diagnosis of tic disorder and stereotypical movement disorder and how these clinical findings are related to disease symptoms and symptom severity. This research, which we conducted with the hypothesis that tic disorder and stereotypical movement disorder have different neurobiological mechanisms, is a cross-sectional study that clinically evaluated motor skills and SNS. Our study sample consisted of 20 children diagnosed with tic disorder, 20 children with stereotypic movement disorder, 13 children with Attention Deficit Hyperactivity Disorder (ADHD), and 20 healthy controls. In addition to the Schedule for Affective Disorders and Schizophrenia for School-Age Children-Present and Lifetime Version, DSM-5 (K-SADS-PL) psychiatric diagnostic interview, all participants were given Yale General Tic Severity Scale (YGTSS), Neurological Evaluation Scale (NES), Repetitive Behavior Scale-Revised (RBS-R), Conners’ Parent Rating Scale-Revised Short Form (CPRS-RS), Revised Developmental Coordination Disorder Questionnaire (DCDQ-R), Nine-Hole Peg Test, Flamingo Balance Test, 1-Minute Sit-to-Stand Test, Finger to Nose with Eyes Closed Test. There was no significant difference between the groups in terms of age, gender, socioeconomic level, parental age, perinatal factors, developmental stages, hand, foot, and eye preferences, and cerebral dominance. While the tic history of fathers' was significantly higher in the tic disorder group, the mothers' stereotypy history was markedly higher in the stereotypy group. Asthma comorbidity was found to be high in both movement disorder groups. In the stereotypic movement disorder group, NES's "Sequencing of Complex Motor Acts" sub-scale score and fist-ring test were significantly higher than healthy controls, and Ozeretski test score was significantly higher than both the tic disorder and the healthy control groups. The "Sequencing of Complex Motor Acts" sub-scale and fist-ring test scores were significantly higher in the ADHD group compared to healthy controls. A significant difference was found between stereotypic movement disorder and tic, ADHD, and healthy control groups regarding the time of removing pegs for the dominant and non-dominant hands of the Nine-Hole Peg Test. It was observed that in the tic group, there was a tendency to improve fine motor skill performance as YGTSS scores increased. There was no significant difference between groups for Flamingo Balance Test and Finger to Nose with Eyes Closed Test scores. In the tic disorder group, there was a significant correlation between balance performance and the scores of oppositional behavior and cognitive problems/inattention subscales of the CPRS-RS. In the stereotypy group, 1-Minute Sit-to-Stand Test performance was significantly lower than healthy controls, and we observed that these scores were not correlated with RBS-R scores. In addition to the total score of DCDQ-R, fine motor/handwriting and general coordination subscale scores were significantly lower in stereotypy, tic, and ADHD groups compared to healthy controls. We observed a significant difference in control ability during movement subscale and risk of Developmental Coordination Disorder (DCD) between the stereotypy group and healthy controls. The results of our study revealed that school-age children with stereotypic movement disorder are more likely to have fine and gross motor dysfunctions, problems in sequencing complex motor acts, and a higher risk of DCD than children with tic disorders. Our results indicate that the pathogenesis of these two movement disorders may be related to different neurobiological processes. Investigation of biological factors that may play a role in the differential diagnosis of tic disorder and stereotypical movement disorder in the future will increase our knowledge in this area.