Diagnosis and Management of Functional Tic-Like Phenomena 2022 Malaty et al

Abstract

Over the past 3 years, a global phenomenon has emerged characterized by the sudden onset and frequently rapid escalation of tics and tic-like movements and phonations. These symptoms have occurred not only in youth known to have tics or Tourette syndrome (TS), but also, and more notably, in youth with no prior history of tics. The Tourette Association of America (TAA) convened an international, multidisciplinary working group to better understand this apparent presentation of functional neurological disorder (FND) and its relationship to TS. Here, we review and summarize the literature relevant to distinguish the two, with recommendations to clinicians for diagnosis and management. Finally, we highlight areas for future emphasis and research.

Open access, https://www.mdpi.com/2077-0383/11/21/6470/htm

 

So they got different people to review the same thing that exists only as an impression because it has no useful definition and uses circular reasoning. Because we say so, even though they look the same, and we have huge expectation biases. But trust us, we're experts who use circular reasoning.

This is their review of how to differentiate. That's the whole section: other people think the same thing based on the same formula that has no formal validity. Which they do at a distance, without talking with the patients, whom they never even see. From mere videos, which could be made for fun, trolling or a number of reasons that must include the fact that using specific features to define something will obviously miss out many since the definitions and features used cannot be assumed to be complete and whole. This is similar reasoning to dismissing COVID as a possibility because someone didn't travel to China. Arbitrary definitions lead to arbitrary, well, as they say, impressions.

The problem with peer review is what happens when all the peers are wrong and validate each others' errors because the entire field is in error? Well, you get a strong consensus for error. Which is sadly the real model of evidence-based medicine. Right or wrong, ultimately it works exactly the same as a legislature: people make their case then vote on it. If they vote unanimously on BS, then BS is now the truth. What a great system, so easy to game because no one cares about gaming the system, it seems.

 

As someone who personally has tics, I'm not sure how to parse this article. Tourette's is diagnosed from signs and symptoms alone, and the frequency and nature of my tics seem to vary both randomly and with my mental state. For example, I don't have tics when I'm completely engrossed in something. There's no clear biomarker for tics either. Some aspects of this disorder seem exactly like FND, except Tourette's is accepted as a "legitimate" condition. Considering these aspects of Tourette's, trying to distinguish between "real" and "functional" tics seems like more an exercise in philosophy than science.

Sure, videos on the unaptly named TikTok might drive kids to clinics....but are more people actually coming to neuro clinics? Do the same number of people having tics but more are seeing a doctor because of awareness? Are the same number of people having tics but in different patterns because of what they say? (I don't say this to be patronizing. I legitimately have tics influenced by various traumatic events.)

The neurologists also have a weird idea the complex tics are "functional"? n=1 here, but I've been doing tics in patterns for almost 20 years now. Some of the earliest tics I had followed complex self-similar patterns.