Tourette syndrome (TS) is characterized by chronic waxing and waning motor and vocal tics and usually begins between the ages of twelve and fifteen years and affects boys more frequently than girls. About half of the patients start with simple motor tics such as frequent eye blinking, facial grimacing, head jerking, shoulder shrugging, or with simple vocal tics such as throat clearing, sniffing, grunting, snorting, hissing, barking, and other noises. Most patients then develop more complex tics and mannerisms such as squatting, hopping, skipping, hand shaking, compulsive touching of things, people, or self, and other stereotypical movements. The tics may change from one form to another. Although described as a lifelong condition, up to one third of patients eventually achieve spontaneous remission during adulthood. Coprolalia, echolalia, and echopraxia are the most dramatic symptoms of TS, but are present in a minority of patients. In addition to the motor and vocal tics described earlier, many patients have behavioral disorders including obsessive-compulsive disorder, attention deficit-hyperactivity disorder, self-destructive behavior, depression,
XI. Drug-Induced Movement Disorders
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