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Tics in PANDAS vs transient/Tourette's/etc


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My son presented with a sudden onset of multiple motor tics immediately after having strep twice in one month. With an aware and responsive pediatrician, we had ASO and ADB results about two weeks later and started on Augmentin. After some initial worsening(herxing?), we saw a dramatic improvement, and the tics went from nearly constant to only when he's really tired or when playing his sport.

 

There is a little voice in the back of my mind wondering if it's really PANDAS or something else, although the high ASO and ADB and dramatic improvement with antibiotics lead me to think we're on the right track.

 

I've been reading up on tics and tic disorders, and I wondered if tics present differently in PANDAS than they do in other situations.

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Your story seems to support PANDAS. As for whether Pands tics look different than TS tics - no. They appear to be the same. The difference is more 1. in Pandas, the tics decline/resolve when you treat the infection and 2. in Pandas, the tics come with other symptoms such as anxiety. OCD, dysgraphia (decline in handwriting), hyperactivity, urinary frequency or other changes.

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I have also read somewhere at some time that the PANDAS- type tics don't necessarily stay the same as they come & go. Tourettes supposedlt has a more consistent type of tic(s) for the kid once he has it. Boy, we have certainly had the morphing tics here over the years.

 

Jump in if this is way off. Dawn

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We've got 3 motor tics only, no vocal, and they're all facial. He seems to have added a nose scrunch grimace today, but he also has a stuffy nose and cough, so I'm still on the fence about that one. It's interesting to me that they're all facial, but I think I'm grateful for that.

Edited by Crunchfly
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For TS, I believe you need both motor and vocal tics:

Tourette syndrome is defined by multiple motor and vocal tics lasting for more than one year. I also believe the definition says if you go more than 3 months without tics, it isn't TS but is classified as a transient tic disorder.

 

The reason I always balked at a TS diagnosis for my son (who since proper treatment for Pandas/lyme - goes 18 months or more w/o tics) is that I didn't want to use a medication or supplement on a long term basis for a transient symptom. I also wanted to make sure we were getting at the root cause. TS treatments focus on managing symptoms, not eliminating the trigger.

 

Like Dawn, our tics always morphed. Some showed up more than others, but it was always a changling. And they were movements that were partially OCD-driven - he had to do movements to "feel right". Very hard to tease out what was a tic and what was OCD. In the end, the label depends on what happens when you treat. IMO, if you treat with antibiotics and the symptoms lessen/resolve, it's PANS. If they don't, then you need to look for other triggers like mold or toxins or diet. If that doesn't help and you've exhausted all other options, then and only then would I resign myself to a TS diagnosis. But just my opinion.

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