M., a 7 years. boy, presented at our hospital suffering from multiple worsening motor and vocal tics for 6 months. During hospitalisation, high CPK levels and localised, non-traumatic, bruising on both upper and lower limbs were noted. Toxic and infective causes were excluded, as inflammatory markers, throat swab, EBV were negative. MRI, EEG, SPECT showed no pathological findings. Epilepsy was excluded too. The YGTSS (Yale Tic Severity Scale) showed a score of 80/100. According to Diagnostic and Statistical Manual of Mental Disorders DSM V criteria and in view of the recent onset of symptoms (less than 12 months), the condition of Transient Tics was diagnosed. A treatment with Pimozide (1 mg/day) was therefore started. After 48 hour of treatment, a prompt clinical and laboratoristic response was observed, with reduction of tics, vanishing of limb bruises and CPK normalisation. Currently, after 17 months, M. still suffers from tics. Because of symptoms persisting more than 12 months, according to DSM V criteria, the diagnosis was therefore shifted into Tourette Syndrome. Tourette S. is characterised by multiple motor and vocal tics starting before the age of 18. They usually tend to vanish at maturity and may be associated with Attention Deficit Hyperactivity Disorder (ADHD) and Obsessive Compulsive Disorders (OCD).
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