3 Moreover, the suppression of tics for a certain time is a diagnostic

feature of TS, especially in situations where the patient’s attention is drawn to them (eg, during a medical examination). In particular, typical but awkward symptoms such as coprolalia, copropraxla, or echolalla, are often concealed. Regarding the differential diagnosis of TS (Table III), other tic selleck compound disorders Inhibitors,research,lifescience,medical such as chronic motor tic disorder, which lacks vocal tics, must be excluded. In cases where the disorder starts later than the consensus age of 18 or 21 years, even full-blown TS symptoms cannot be diagnosed as TS (DSM-IV).1 Table III Development of DNA sequencing. Extrapyramidal movement disorders, but also OC symptoms, are known to occur as a symptom of poststreptococcal disease, such as in Sydenham’s chorea, for a long time.20,21 Huntington’s disease, today easily diagnosed by molecular genetic Inhibitors,research,lifescience,medical methods, is a movement disorder often showing similar phenomena to TS; this differential diagnosis needs to be kept in mind. Pharmacologically induced hyperkinesia, induced by, eg, L-dopa or amphetamine, is an important differential diagnosis, but tardive dyskinesias, caused by antipsychotic

therapy, often show similar motor symptoms to tics. Moreover, schizophrenia is often associated with movement abnormalities such as stereotypic Inhibitors,research,lifescience,medical movements and motor automatisms, the latter also frequently found in organic brain disorders. This has to be considered as well, particularly since schizophrenia and TS have common pathogenetic features and co-occur in certain cases.22 Inhibitors,research,lifescience,medical Apart from schizophrenia, psychogenic movement

disorders are an important psychiatric differential diagnosis in TS. Neuroacanthocytosis is another group of neuropsychiatrie disorders which shows features of TS. Primarily, it is characterized by abnormal erythrocytes in the blood, acanthocythes, which seem to be the result of a hereditary component and represent an impairment of structural proteins of the cellular membrane. The first symptom of neuroacanthocytosis is often an epileptic seizure, but OC symptoms, symptoms of ADHD, or tics are Inhibitors,research,lifescience,medical Tolmetin described as manifestations of the condition.23,24 In some recent studies, in patients primarily presenting with tics, genetic defects belonging to the group of neuroacanthocytosis syndromes, such as chorea-acanthocytosis, have been reported.25,26 TS is not only a movement disorder, but a psychiatric disorder Because of its rich clinical expression and frequent association with comorbid disorders, the spectrum of TS is often not recognized or fully appreciated. As our knowledge about TS expands, however, it is becoming increasingly obvious that TS is not merely a movement disorder, manifested by motor and vocal tics, but a relatively common neurobehavioral complex manifested, in addition to tics, by attention deficit, OC symptoms, lack of impulse control, and a variety of other behavioral symptoms.