strange symptoms

I have been seeing a neurologist for a sudden onset of tourrette like motor tics (I am 34 years old) and we are all confused now as new symptoms are occuring. I occasionally experience miosis, I become over startled with sound and touch, and I have lost my fine motor control with my fingers (dropping things etc). Occasioanlly my hands and fingers cramp up as well. I have no history of anything related in my family (though my son has OCD), my health is excellent, no drugs, no previous trauma. Occasionally I also experience tics in the face and this all began 9 months ago with persistent clicking in my ears. All bloodwork and image/neuro tests have been negative. Any ideas?

[Godofredo MD]

Hi.

The medical literature on tic disorders found in adulthood have been very sparse. However, the incidence of these disorders are not as rare as was commonly believed,

Your condition could probably be related to one of 2 classifications of adult-onset tic disorders, the secondary type and the idiopathic type.

You should be first assessed for adult-onset secondary tic disorder by eliminating possible causes of this condition including:  

- drugs causing tardive tics such as amphetamines, methylphenidate, pemoline,
levodopa, cocaine, carbamazepine, phenytoin, phenobarbital, lamotrigine, antipsychotics, and other dopamine-receptor–blocking drugs
- Toxins such as carbon monoxide
- Infections such as encephalitis, Creutzfeldt–Jakob disease, etc.
- Developmental problems such as static encephalopathy, mental-retardation
syndromes, chromosomal abnormalities, Asperger’s syndrome
- Other including head trauma, stroke, schizophrenia, neurodegenerative diseases

If no cause is found, a diagnosis of idiopathic adult-onset tic disorder can be considered. Clinical evidence supports the concept that tic disorders in adults are part of a range that includes childhood onset tic disorders and Tourette's syndrome (Chouinard, et al. Adult-onset tic disorders. J Neurol Neurosurg Psychiatry 2000;68:738-743 ( June )).

Hope this information is helpful to you.