New-onset functional tics during the COVID-19 pandemic: Clinical characteristics of 105 cases from a single centre

A.E. Cavanna, G. Purpura, A. Riva, R. Nacinovich, S. Seri

Research output: Contribution to journalArticlepeer-review


Background and purpose
The COVID-19 pandemic has been associated amongst other things with a sharp increase in adolescents and young adults presenting acutely with functional tics. Initial reports have suggested clinically relevant differences between functional tics and neurodevelopmental tics seen in primary tic disorders such as Tourette syndrome. We aimed to provide confirmatory findings from the largest single-centre cohort to date.

In the present study we present data from 105 consecutive patients who developed functional tics during a 3-year period overlapping with the COVID-19 pandemic (April 2020–March 2023). All patients underwent a comprehensive neuropsychiatric assessment at a single specialist centre for tic disorders.

Female adolescents and young adults accounted for 69% of our sample. Functional tics had an acute/subacute onset in most cases (75% with a peak of severity within 1 month). We found a disproportionately high frequency of complex movements (81%) and vocalizations (75%). A subset of patients (23%) had a pre-existing primary tic disorder (Tourette syndrome with functional overlay). The most common psychiatric co-morbidities were anxiety (70%) and affective disorders (40%). Moreover, 41% of patients had at least one functional neurological disorder in addition to functional tics. Exposure to tic-related social media content was reported by half of the patients.

Our findings confirm substantial clinical differences between functional tics developed during the pandemic and neurodevelopmental tics. Both patient- and tic-related red flags support the differential diagnostic process and inform ongoing monitoring in the post-pandemic era.
Original languageEnglish
Pages (from-to)2411-2417
Number of pages7
JournalEuropean Journal of Neurology
Issue number8
Early online date26 May 2023
Publication statusPublished - Aug 2023

Bibliographical note

Copyright © 2023 The Authors. European Journal of Neurology published by John Wiley & Sons Ltd on behalf of European Academy of Neurology.
This is an open access article under the terms of the Creative Commons Attribution-NonCommercial License, which permits use, distribution and reproduction
in any medium, provided the original work is properly cited and is not used for commercial purposes.


  • Tourette syndrome
  • functional neurological disorder
  • functional tics
  • neurodevelopmental tics
  • tic disorder


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