Seizures vs Tourette Syndrome/tics vs Asperger Syndrome

My son is 11 years old.  After much concern, we finally were lead to a neurologist and an autism team who diagnosed him with Autism Spectrum Disorder/Asperger Syndrome at the age of 5.  He is very bright but has many features that fit with that diagnosis.  
  Due to some other problems and accidental testing, he was found to have a very large arachnoid cyst between the 2 lateral ventricles resulting in some hydrocephalus.  He has had 2 surgeries for that.  The size has reduced but because of the vascular nature of the cyst, a complete festration to the far lateral ventricle wasn't as successful.  He had some hemorrhaging in the last surgery.
  When seeing a new neurologist this spring (the other retired), she said it was not Asperger Syndrome but Tourette Syndrome.
My son was had chin and hand tremors as a baby.  That was passed off.
He had blinking starting at 2 1/2.  He was fitted for glasses.
He did ALOT of sniffing and throat clearing.  He was treated for allergies.
He was having anger/rage episodes that would abruptly start and then just as abruptly stop after a couple of weeks.
We took him to someone who prescribed a medication that bumped him up into some major eye rolling tics and head jerking tics.  We took him off the meds and have been told that since that was an anti-tic med to be careful about having him on anything for a neurological problem.
  Before the surgeries, he had several times where he would fall to the floor and not be able to get up.  He would describe things as being far away and could not always understand us. He said that he could remember when this happened also when he was very young and in his crib. He said sometimes he saw double.  He said sometimes, he heard voices.  He rarely will mention anything wrong with him and won't talk about these incidents again.  Because these occurred with headaches - the docs dismissed them as headache/migraine/manipulation until we got the cyst diagnosis.
  I have been reading in a seizure site how many of these symptoms are also associated with complex partial seizures.  He had a sleep EEG at 7 yrs old which was normal.
  
My questions are:
How can you tell the difference between a tics and seizures?
Should I investigate this or am I buying trouble?

My son is basically doing alright.  He gets As and Bs in school.  He is a wonderful, fun kid.  He never seems to fit solidly into any symptom range so everyone overlooks the problems he has.  If these things are seizures, I would like to have them treated.  I understand the seizures can evolve into worse types of seizures.  However, I don't want to put him on any type of medication that might give him more grief than he has to deal with already.  And, I don't want to go to his neurologist with some half-baked questions.
Thanks,
kd

  

[CCF Neuro[P] MD, RPS]

Dear KD:

Sorry to hear about the problems your son is having.  The usual onset of Tourette's syndrome is 5 to 10 years of age.  I would not classify any tic behavior before this time unless it is very prominant.  In Tourette's, the tics must be motor and vocal, lasting at least 1 year or not having breaks or remissions longer than 3 months.  Having strictly motor tics does not qualify as Tourette's but simple motor tics, or just vocal tics is just simple vocal tics.  There are co-morbid processes with Tourette's such as ADHD and OCD which occur in a percentage of patients.  Tourette's syndrome children have no more frequent epilepsy as the general population.  They can have epilepsy but this, as in the general population is not common.  It is fairly easy to see if the tics are actually epileptic seizures as a stay in a video monitoring unit with EEG will solve the problem as one can see if seizure activity drives the motor tic.  Repeatative behaviors or stereotypies are usually seen in PPD spectrum disorders.  These motions are repetitive and can look like seizure activities.  They usually do not cause the patient to loose consciousness and they are very repetitive in nature, in other words are alike from event to event.  So, as one can see, they can look like seizures.  

I would think the first thing to do is sort out the epilepsy issue and see if there is an EEG correlate with the motor movements.  Then if negative, I would seek out someone who is familiar with Tourette's and PDD.  Behaviors are not tics, and should be able to be discerned.

I hope that things get cleared up.

Sincerely,

CCF Neuro MD

[lola69]

A related discussion, tics was started.