A recent study examined sex-based differences in Tourette syndrome and persistent motor or vocal tic disorder, revealing significant disparities in diagnosis timing, tic severity, and comorbid conditions.
In the study, published in Neurology, investigators analyzed 2,403 individuals (2,109 with Tourette syndrome [TS] and 294 with persistent motor or vocal tic disorder [PMVT]) from the Tourette Association of America International Consortium for Genetics (TAAICG) data set. Female participants with TS were significantly less likely to have been formally diagnosed prior to participating in the study, with 0.46 times lower odds compared with male participants (P < .00001). Additionally, female participants experienced tic symptoms that began later (mean age = 6.5 ± 2.8 years vs 6.0 ± 2.7 years, P = .001) and were diagnosed later (mean age = 13.3 ± 11.2 years vs 10.7 ± 8.1 years, P = .0001) compared with male participants. Time-to-diagnosis was also longer among female participants (median = 3 years [1,7] vs 2 years [1,5], P = .01).
"We were more limited in our PMVT analysis because the TAAICG study was focused on TS, and age at PMVT diagnosis was not available. Female participants with PMVT had an earlier age at tic symptom onset compared with female participants with TS, which could be related to recall bias," said lead study author Marisela E. Dy-Hollins, MD, of the Department of Neurology at Massachusetts General Hospital and Harvard Medical School, and her colleagues. "Many participants with PMVT were older than participants with TS and primarily, although not exclusively, consisted of parents of children with TS," they explained, emphasizing that "for the younger participants, the information likely came from their parents because they might be too young or not aware of all their tics (eg, if tics were mild)."
Female participants with TS had higher rates of obsessive-compulsive disorder (OCD) compared with male participants (55.0% vs 48.7%, P = .01), whereas attention-deficit/hyperactivity disorder (ADHD) was more prevalent in male patients (55.7% vs 38.9%, P < .001). No statistically significant differences were observed in ADHD onset age (P = .16). Adjusted analyses confirmed these disparities, showing that female participants had a 1.3 times higher risk of OCD (P = .02) and a 0.6 times lower risk of ADHD (P < .001).
Among PMVT participants, OCD was also more prevalent in female participants (41.9% vs 22.2%, P < .001). Female participants with PMVT had a 2.4 times higher risk of OCD (P = .001) and a 1.7 times higher risk of both ADHD and OCD (P = .03).
The findings highlighted sex-based disparities in the diagnosis and clinical characteristics of tic disorders. Female participants with TS were less likely to receive early diagnosis and had lower tic severity scores. Differences in comorbidities further emphasized the need for tailored approaches to clinical assessment and management of tic disorders.
The investigators called for further research to better understand sex-based variations over time and their implications for treatment strategies.
Full disclosures are detailed in the study.
