Functional tics: Expanding the phenotypes of functional movement disorders?

Andrea E. Cavanna*, Giulia Purpura, Anna Riva, Renata Nacinovich, Stefano Seri

*Corresponding author for this work

Research output: Contribution to journalArticlepeer-review


Background and purpose: Until the outbreak reported during the COVID-19 pandemic, functional tics were considered to be a relatively rare clinical phenotype, as opposed to other functional movement disorders such as functional tremor and dystonia. To better characterize this phenotype, we compared the demographic and clinical characteristics of patients who developed functional tics during the pandemic and those of patients with other functional movement disorders. Methods: Data from 110 patients were collected at the same neuropsychiatry centre: 66 consecutive patients who developed functional tics without other functional motor symptoms or neurodevelopmental tics and 44 patients with a mix of functional dystonia, tremor, gait, and myoclonus. Results: Both groups were characterized by female sex preponderance (70%–80%) and (sub)acute onset of functional symptoms (~80%). However, patients with functional tics had a significantly earlier age at onset of functional symptoms (21 vs. 39 years). Exposure to relevant social media content was reported by almost half of the patients with functional tics, but by none of the patients with other functional movement disorders. Comorbidity profiles were similar, with relatively high rates of anxiety/affective symptoms and other functional neurological symptoms (nonepileptic attacks). Conclusions: Patients who developed functional tics during the pandemic represent a phenotypic variant of the wider group of patients with functional movement disorders, associated with younger age at onset and influenced by pandemic-related factors, including increased exposure to specific social media content. Diagnostic protocols and treatment interventions should be tailored to address the specific features of this newly defined phenotype.

Original languageEnglish
Article number15967
Pages (from-to)3353-3356
Number of pages4
JournalEuropean Journal of Neurology
Issue number10
Early online date6 Jul 2023
Publication statusPublished - Oct 2023

Bibliographical note

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.© 2023 The Authors.


  • functional movement disorders
  • functional neurological disorder
  • functional tics
  • neurodevelopmental tics
  • tic disorder
  • Tourette syndrome
  • Tics/epidemiology
  • Pandemics
  • Tremor
  • COVID-19/complications
  • Dystonic Disorders/complications
  • Humans
  • Tic Disorders/epidemiology
  • Tourette Syndrome/diagnosis
  • Female
  • Dystonia
  • Conversion Disorder/epidemiology


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