Differentials
Provisional tic disorder
SIGNS / SYMPTOMS
Motor and/or vocal tics for less than 1 year.
INVESTIGATIONS
Diagnosis is based on history and physical examination.
Persistent (chronic) motor or vocal tic disorder
SIGNS / SYMPTOMS
Either only motor or only vocal tics for more than 1 year.
INVESTIGATIONS
Diagnosis is based on history and physical examination.
Stereotypies
SIGNS / SYMPTOMS
Can be seen in normal children but often in children with pervasive developmental disorders. Common ones include head banging, body rocking, and repetitive finger movements.
INVESTIGATIONS
Diagnosis is based on history and physical examination.
Akathisia
SIGNS / SYMPTOMS
An abnormal state of excessive restlessness accompanied by feeling the need to move about, with relief gained after moving. Often seen in the context of dopamine receptor-blocking agent exposure, both acutely and chronically.
INVESTIGATIONS
Diagnosis is based on history and physical examination.
Compulsions and obsessions (including OCD)
SIGNS / SYMPTOMS
Although compulsions are also usually associated with feelings of inner anxiety, they are characterised by ritualistic behaviours (checking, touching, arranging, etc.) and the need to repeat them in the same manner. Obsessions are closely linked and are defined as recurrent, often undesired, intrusive thoughts.
INVESTIGATIONS
Diagnosis is based on history and physical examination.
Paediatric auto-immune neuropsychiatric disorders associated with streptococcus (PANDAS)
SIGNS / SYMPTOMS
By definition, abrupt or explosive onset or exacerbation of tics and/or OCD in pre-pubertal children in temporal association with laboratory evidence of a streptococcal infection.
Paediatric acute-onset neuropsychiatric syndrome (PANS)
SIGNS / SYMPTOMS
A syndrome with primary diagnostic criteria of acute-onset OCD, with secondary features of anxiety, emotional lability, irritability, aggression, behavioural regression, deterioration in school performance, sensory or motor abnormalities, and somatic signs and symptoms such as loss of handwriting skills or frequent urination.
INVESTIGATIONS
Positive throat culture.
Positive anti-streptolysin O antibodies (peak at 3 to 6 weeks) and antiDNAase B antibodies (peak at 6 to 8 weeks).[61][62]
FBC with differential, comprehensive metabolic panel, ESR, and CRP.
Urinalysis to exclude urinary tract infection.
ANA may be positive.
Consideration of other infectious aetiologies with Lyme disease and Mycoplasma infection serology.[57]
Myoclonus
SIGNS / SYMPTOMS
Involuntary brief, jerk-like movement. Can be irregular and is not preceded by the urge to perform the movement.
INVESTIGATIONS
Diagnosis is usually based on history and physical examination.
Wilson's disease
SIGNS / SYMPTOMS
Kaiser-Fleischer rings, parkinsonism, slow high-amplitude proximal tremor.
INVESTIGATIONS
Increased serum copper levels and low serum ceruloplasmin levels.
MRI with symmetrical T2 hyper-intensities in the bilateral basal ganglia and mesencephalon with sparing of the red nuclei.
Huntington's disease
SIGNS / SYMPTOMS
Involuntary choreic movements not associated with an urge to move. By definition, these movements should be random and not stereotyped.
INVESTIGATIONS
Positive genetic testing for Huntington's disease.
Sydenham's chorea
SIGNS / SYMPTOMS
Develops weeks to months after streptococcus infection, characterised by chorea and truncal movements.
INVESTIGATIONS
Diagnosis is usually based on history and physical examination.
Allergic rhinitis
SIGNS / SYMPTOMS
May present with sniffing, eye blinking, and throat clearing.
INVESTIGATIONS
Skin testing may reveal causative allergen. Response to a therapeutic trial of antihistamine or intranasal corticosteroid.
Conjunctivitis
SIGNS / SYMPTOMS
May present with eye blinking.
INVESTIGATIONS
Positive adenovirus immunoassay in adenovirus infection.
Positive culture for bacterial or viral infection.
Cough-variant asthma
SIGNS / SYMPTOMS
Chronic cough following exposure to allergens or upper respiratory infection.
INVESTIGATIONS
Physical examination; response to bronchodilators or corticosteroids.
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