(PO-011) Tics Following COVID-19 and Response to Treatment
Neuropsychiatric symptoms can be part of Covid-19 illness (Ahmad, 2020). There is no report in the literature so far of a tic disorder developing in an adult after Covid infection. The author reports such a case.
A 50 yo man with panic disorder and generalized anxiety disorder, in partial remission on escitalopram 20mg daily and clonazepam 0.5mg prn, became ill with Covid-19 in March 2020. He did not require hospitalization. The acute illness lasted 16 days, with fatigue, headache, confusion, and fever. He worried in a ruminative manner about job security. Three weeks after onset of Covid he developed spitting tics, approximately once every 15 minutes, with just one spitting.at a time. There was no salivary accumulation. He carried a paper towel with him all the time to spit. If he tried to stop the spitting he could not. There was no characteristic of an obsessive-compulsive disorder. There were no thoughts or feelings preceding or following the tic. He had a prior history of similar tics at age 8 that remitted after 2 months without treatment. There was no history of Tourette’s disorder. Thus he met the criteria for provisional tic disorder. Because of prior adverse reaction to aripiprazole prescribed for anger control, instead of trying a dopamine receptor blocking agent, escitalopram was increased to 25 mg daily. Because spitting did not improve, escitalopram was further increased to 30 mg daily, at which point spitting tics disappeared completely. Because of anorgasmia on this dosage, he reduced escitalopram to 25 mg daily. Ability to orgasm returned, but so did the tics. Upon increasing escitalopram to 30 mg daily again, the tics disappeared, but anorgasmia returned. Cyproheptadine 4 mg 90 minutes before sexual intercourse restored his orgasm without interfering with remission of tic disorder, but caused sedation.. After a remission of 9 months, and after addition of gabapentin 300 mg tid to successfully treat anxiety that emerged after Covid vaccination, when.he reduced escitalopram daily dose to 15 mg the tics relapsed. The tics remitted again when he increased escitalopram daily dose to 20 mg, and the remission was maintained at follow-up a month later.
An increase in tics in adolescents (Isobel, 2020), and perceived worsening of tics in adult patients with Tourette Syndrome (Mataix-Cols, 2021) in the context of increased anxiety in the Covid pandemic have been reported. In this case it is not clear if tic disorder got reactivated by Covid encephalopathy or anxiety.
Relative contributions of neurologic and psychological factors to post-Covid neuropsychiatric manifestations need to be explored.
Ahmad I, Rathore FA. Neurological manifestations and complications of COVID-19: A literature review. Journal of Clinical Neuroscience. 2020; 77:8-12
Heyman I, Liang H, Hedderly T. COVID-19 related increase in childhood tics and tic-like attacks. doi: 10.1136/archdischild-2021-321748
Mataix-Cols D, Ringberg H, Fernández de la Cruz L. Perceived worsening of tics in adult patients with Tourette Syndrome after the COVID-19 outbreak. Movement Disorders Clinical Practice 2020;7:725–726
Know how to differentiate tic disorder from obsessive-compulsive disorder
Know that both psychological and biological factors may contribute to Covid-related neuropsychiatric illness