ADULT-ONSET TICS ASSOCIATED WITH PERIPHERAL INJURY

We report the cases of two patients with adult-onset, simple, nonvaryi ng tic disorder that commenced after a peripheral (non-CNS) injury. Th e first patient is a 38-year-old man who suffered a right facial injur y when his car fell off its jack while he was working underneath. Bila teral facial twitching began hours after the trauma and was characteri zed as a sniffinglike gesture. The movements waxed and waned, were sup pressible, and were associated with a premonitory sensation. The ties remitted after 9 months but still recur occasionally under stressful s ituations. The second patient is a 34-year-old man with a 3-year histo ry of abrupt, rapid head-turning movements that began 12 months after a motor vehicle accident in which he injured his neck, The ties contin ue to wax and wane, are suppressible, and are associated with an urge. Neither patient suffered a head injury or had a family history of Tou rette syndrome. Based on the clinical and historical features of these patients, the temporal relationship between the trauma and onset of t ies, and the occurrence of ties only in the traumatized region, a caus al relationship is possible. These may represent the first reported ca ses of tic disorder in association with peripheral injury. The mechani sm by which the tic disorder resulted from the peripheral injury is un clear, but these patients might have been susceptible individuals and the trauma acted as a trigger.