AccScience Publishing / AN / Online First / DOI: 10.36922/an.8525
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ORIGINAL RESEARCH ARTICLE

Postural orthostatic tachycardia syndrome in patients with tic disorders and functional tic-like behaviors

Andrea E. Cavanna1,2,3,4,5* ,  Silvia Chiereghin4,5 ,  Silvia Ferrari4,5 ,  Giulia Paini4,5 ,  Laura Spini4,5 ,  Giulia Purpura4 ,  Anna Riva4,5 ,  Renata Nacinovich4,5
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1 Department of Neuropsychiatry, National Centre for Mental Health, BSMHFT and University of Birmingham, Birmingham, United Kingdom
2 School of Health and Life Sciences, Aston Brain Centre, Aston University, Birmingham, United Kingdom
3 Sobell Department of Motor Neuroscience and Movement Disorders, Institute of Neurology and University College London, London, United Kingdom
4 Department of Medicine and Surgery, School of Medicine and Surgery, University of Milano-Bicocca, Milan, Italy
5 Department of Child Neuropsychiatry, IRCCS San Gerardo dei Tintori, Monza, Italy
Advanced Neurology, 8525 https://doi.org/10.36922/an.8525
Submitted: 13 January 2025 | Revised: 25 February 2025 | Accepted: 7 March 2025 | Published: 19 March 2025
© 2025 by the Author(s). This article is an open access article distributed under the terms and conditions of the Creative Commons Attribution 4.0 International License ( https://creativecommons.org/licenses/by/4.0/ )
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Abstract

Postural orthostatic tachycardia syndrome (POTS) is an autonomic condition characterized by sustained excessive postural tachycardia, often accompanied by a range of other symptoms of orthostatic intolerance, including heart palpitations, light-headedness, weakness, tremulousness, blurred vision, nausea, headache, dizziness and syncope. POTS predominantly affects young females. Little is known about the exact pathophysiology of this condition; however, preliminary reports about comorbidity profile of POTS suggest a possible link with functional disorders. The striking increase in functional tic-like behaviors (a specific phenotype of functional movement disorder) during the COVID-19 pandemic offered a privileged opportunity to further explore the possible association between POTS and functional neurological disorder. In the present study, we retrospectively assessed the prevalence of POTS in two large patient populations from a specialist clinic for tic disorders: (1) patients with neurodevelopmental tics who received a diagnosis of Gilles de la Tourette syndrome (GTS), and (2) patients who developed tic-like behaviors and received a diagnosis of functional tics since the onset of the COVID-19 pandemic (April 2020 – December 2024). The prevalence of POTS was 0/638 in the GTS group and 4/177 (2.3%) in the functional tics group. The four patients with POTS were females, with age at assessment ranging from 17 to 24 years. In addition to describing their clinical characteristics, we discuss the significance of the selective association between POTS and functional tic-like behaviors, in the absence of comorbidity between POTS and neurodevelopmental tics.

Keywords
Postural orthostatic tachycardia syndrome
Tic disorders
Gilles de la Tourette syndrome
Functional tic-like behaviors
Funding
None.
Conflict of interest
The authors declare that they have no competing interests.
References
  1. Vernino S, Bourne KM, Stiles LE, et al. Postural orthostatic tachycardia syndrome (POTS): State of the science and clinical care from a 2019 National Institutes of Health Expert Consensus Meeting - Part 1. Auton Neurosci. 2021;235:102828. doi: 10.1016/j.autneu.2021.102828

 

  1. Fedorowski A. Postural orthostatic tachycardia syndrome: Clinical presentation, aetiology and management. J Intern Med. 2019;285(4):352-366. doi: 10.1111/joim.12852

 

  1. Staples A, Thompson NR, Moodley M. Pediatric-onset postural orthostatic tachycardia syndrome in a single tertiary care center. J Child Neurol. 2020;35(8):526-535. doi: 10.1177/0883073820916260

 

  1. Khoo A, Saxena Y, Zaidi A, Vaou EO, Hohler AD. Postural orthostatic tachycardia syndrome during pregnancy, labor, and post-delivery: A case series. Advanced Neurol. 2024;3(2):3164. doi: 10.36922/an.3164

 

  1. Narasimhan B, Calambur A, Moras E, et al. Postural orthostatic tachycardia syndrome in COVID-19: A contemporary review of mechanisms, clinical course and management. Vasc Health Risk Manag. 2023;19:303-316. doi: 10.2147/VHRM.S380270

 

  1. Sebastian SA, Co EL, Panthangi V, et al. Postural orthostatic tachycardia syndrome (POTS): An update for clinical practice. Curr Probl Cardiol. 2022;47(12):101384. doi: 10.1016/j.cpcardiol.2022.101384

 

  1. Raj SR, Bourne KM, Stiles LE, et al. Postural orthostatic tachycardia syndrome (POTS): Priorities for POTS care and research from a 2019 National Institutes of Health Expert Consensus Meeting - Part 2. Auton Neurosci. 2021;235:102836. doi: 10.1016/j.autneu.2021.102836

 

  1. Qu HQ, Hakonarson H. Navigating complexity in postural orthostatic tachycardia syndrome. Biomedicines. 2024;12(8):1911. doi: 10.3390/biomedicines12081911

 

  1. Olshansky B, Cannom D, Fedorowski A, et al. Postural orthostatic tachycardia syndrome (POTS): A critical assessment. Prog Cardiovasc Dis. 2020;63(3):263-270. doi: 10.1016/j.pcad.2020.03.010

 

  1. Cantrell C, Reid C, Walker CS, et al. Post-COVID postural orthostatic tachycardia syndrome (POTS): A new phenomenon. Front Neurol. 2024;15:1297964. doi: 10.3389/fneur.2024.1297964

 

  1. Mallick D, Goyal L, Chourasia P, et al. COVID-19 induced postural orthostatic tachycardia syndrome (POTS): A review. Cureus. 2023;15(3):e36955. doi: 10.7759/cureus.36955

 

  1. Toepfner N, Brinkmann F, Augustin S, et al. Long COVID in pediatrics-epidemiology, diagnosis, and management. Eur J Pediatr. 2024;183(4):1543-1553. doi: 10.1007/s00431-023-05360-y

 

  1. Cavanna AE, Ganos C, Hartmann A, Martino D, Pringsheim T, Seri S. The cognitive neuropsychiatry of Tourette syndrome. Cogn Neuropsychiatry. 2020;25(4):254-268. doi: 10.1080/13546805.2020.1760812

 

  1. Robertson MM, Eapen V, Cavanna AE. The international prevalence, epidemiology, and clinical phenomenology of Tourette syndrome: A cross-cultural perspective. J Psychosom Res. 2009;67(6):475-483. doi: 10.1016/j.jpsychores.2009.07.010

 

  1. Neal M, Cavanna AE. ‘Not just right experiences’ in patients with Tourette syndrome: Complex motor tics or compulsions? Psychiatry Res. 2013;210(2):559-563. doi: 10.1016/j.psychres.2013.06.033

 

  1. Eddy CM, Cavanna AE, Tourette syndrome and obsessive compulsive disorder: Compulsivity along the continuum. J Obsessive Compuls Relat Disord. 2014;3(4):363-371. doi: 10.1016/j.jocrd.2014.04.003

 

  1. Cavanna AE. Gilles de la Tourette syndrome as a paradigmatic neuropsychiatric disorder. CNS Spectr. 2018;23(3):213-218. doi: 10.1017/S1092852918000834

 

  1. Cavanna AE, Luoni C, Selvini C, et al. Disease-specific quality of life in young patients with Tourette syndrome. Pediatr Neurol. 2013;48(2):111-114. doi: 10.1016/j.pediatrneurol.2012.10.006

 

  1. Cavanna AE, Luoni C, Selvini C, et al. Parent and self-report health-related quality of life measures in young patients with Tourette syndrome. J Child Neurol. 2013;28(10):1305-1308. doi: 10.1177/0883073812457462

 

  1. Martino D, Cavanna AE, Robertson MM, Orth M. Prevalence and phenomenology of eye tics in Gilles de la Tourette syndrome. J Neurol. 2012;259(10):2137-2140. doi: 10.1007/s00415-012-6470-1

 

  1. Eddy CM, Cavanna AE. ‘It’s a curse!’: coprolalia in Tourette syndrome. Eur J Neurol. 2013;20(11):1467-1470. doi: 10.1111/ene.12207

 

  1. Rajagopal S, Seri S, Cavanna AE. Premonitory urges and sensorimotor processing in Tourette syndrome. Behav Neurol. 2013;27(1):65-73. doi: 10.3233/BEN-120308

 

  1. Cox JH, Seri S, Cavanna AE. Sensory aspects of Tourette syndrome. Neurosci Biobehav Rev. 2018;88:170-176. doi: 10.1016/j.neubiorev.2018.03.016

 

  1. Cavanna AE, Black KJ, Hallett M, Voon V. Neurobiology of the premonitory urge in Tourette’s syndrome: Pathophysiology and treatment implications. J Neuropsychiatry Clin Neurosci. 2017;29(2):95-104. doi: 10.1176/appi.neuropsych.16070141

 

  1. Pittenger C. Histidine decarboxylase knockout mice as a model of the pathophysiology of Tourette syndrome and related conditions. Handb Exp Pharmacol. 2017;241:189-215. doi: 10.1007/164_2016_127

 

  1. Mataix-Cols D, Isomura K, Pérez-Vigil A, et al. Familial risks of Tourette syndrome and chronic tic disorders: A population-based cohort study. JAMA Psychiatry. 2015;72(8):787-793. doi: 10.1001/jamapsychiatry.2015.0627

 

  1. Cavanna AE, Purpura G, Riva A, Nacinovich R, Seri S. Functional tics: Expanding the phenotypes of functional movement disorders? Eur J Neurol. 2023;30(10):3353-3356. doi: 10.1111/ene.15967

 

  1. Cavanna AE, Spini L, Ferrari S, et al. Functional tic-like behaviors: From the COVID-19 pandemic to the post-pandemic era. Healthcare. 2024;12(11):1106. doi: 10.3390/healthcare12111106

 

  1. Hull M, Parnes M, Jankovic J. Increased incidence of functional (psychogenic) movement disorders in children and adults amid the COVID-19 pandemic: A cross-sectional study. Neurol Clin Pract. 2021;11(5):e686-e690. doi: 10.1212/CPJ.0000000000001082

 

  1. Nilles C, Pringsheim TM, Martino D. The recent surge of functional movement disorders: Social distress or greater awareness? Curr Opin Neurol. 2022;35(4):485-493. doi: 10.1097/WCO.0000000000001074

 

  1. Valdés-Florido MJ, López-Díaz Á, Palermo-Zeballos FJ, et al. Reactive psychoses in the context of the COVID-19 pandemic: Clinical perspectives from a case series. Rev Psiquiatr Salud Ment. 2020;13(2):90-94. doi: 10.1016/j.rpsm.2020.04.009

 

  1. Nagy P, Cserháti H, Rosdy B, et al. TikTok and tics: The possible role of social media in the exacerbation of tics during the COVID lockdown. Ideggyogy Sz. 2022;75(5- 06):211-216. doi: 10.18071/isz.75.0211

 

  1. Martino D, Hedderly T, Murphy T, et al. The spectrum of functional tic-like behaviours: Data from an international registry. Eur J Neurol. 2023;30(2):334-343. doi: 10.1111/ene.15611

 

  1. Nilles C, Martino D, Pringsheim T. Testing the specificity of phenomenological criteria for functional tic-like behaviours in youth with Tourette syndrome. Eur J Neurol. 2024;31(6):e16262. doi: 10.1111/ene.16262

 

  1. Paulus T, Bäumer T, Verrel J, et al. Pandemic tic-like behaviors following social media consumption. Mov Disord. 2021;36(12):2932-2935. doi: 10.1002/mds.28800

 

  1. Cavanna AE, Purpura G, Riva A, Nacinovich R, Seri S. Neurodevelopmental versus functional tics: A controlled study. J Neurol Sci. 2023;451:120725. doi: 10.1016/j.jns.2023.120725

 

  1. Szejko N, Fletcher J, Martino D, Pringsheim T. Premonitory urge in patients with tics and functional tic-like behaviors. Mov Disord Clin Pract. 2024;11(3):276-281. doi: 10.1002/mdc3.13951

 

  1. Fremer C, Szejko N, Pisarenko A, et al. Mass social media-induced illness presenting with Tourette-like behavior. Front Psychiatry. 2022;13:963769. doi: 10.3389/fpsyt.2022.963769

 

  1. Cavanna AE, Purpura G, Nacinovich R. Neurodevelopmental versus functional tics: The state of the art. Arch Med Health Sci. 2022;10(2):239-246. doi: 10.4103/amhs.amhs_246_22

 

  1. Rigas A, Mainka T, Pringsheim T, et al. Distinguishing functional from primary tics: A study of expert video assessments. J Neurol Neurosurg Psychiatry. 2023;94(9):751-756. doi: 10.1136/jnnp-2022-330822

 

  1. Arbuckle AL, Bihun EC, Schlaggar BL, Black KJ. Functional tic-like presentations differ strikingly from provisional tic disorder. F1000Res. 2023;11:1566. doi: 10.12688/f1000research.129252.2

 

  1. American Psychiatric Association. Diagnostic and Statistical Manual of Mental Disorders, 5th Edition (DSM-5). Washington, DC: American Psychiatric Publishing; 2013.

 

  1. Robertson MM, Eapen V. The National Hospital Interview Schedule for the assessment of Gilles de la Tourette syndrome. Int J Methods Psychiatr Res. 1996;6:203-226. doi: 10.1002/(SICI)1234-988X(199612)6:4<203:AID-MPR165>3.3.CO;2-F

 

  1. Rather MA, Cavanna AE. Nonepileptic attack disorder and functional movement disorder: A clinical continuum? Epilepsy Behav. 2020;106:107028. doi: 10.1016/j.yebeh.2020.107028

 

  1. Cavanna AE, Damodaran L, Purpura G, Nacinovich R. Tourette syndrome with functional overlay: A case series. Arch Med Health Sci. 2022;10(2):312-316. doi: 10.4103/amhs.amhs_247_22

 

  1. Raj V, Opie M, Arnold AC. Cognitive and psychological issues in postural tachycardia syndrome. Auton Neurosci. 2018;215:46-55. doi: 10.1016/j.autneu.2018.03.004

 

  1. Ducroizet A, Zimianti I, Golder D, et al. Functional neurological disorder: Clinical manifestations and comorbidities; an online survey. J Clin Neurosci. 2023;110:116-125. doi: 10.1016/j.jocn.2023.02.014

 

  1. Fisher CJ, Katzan I, Heinberg LJ, et al. Psychological correlates of patients with postural orthostatic tachycardia syndrome (POTS). Auton Neurosci. 2020;227:102690. doi: 10.1016/j.autneu.2020.102690

 

  1. Boylan KA, Dworetzky BA, Baslet G, et al. Functional neurological disorder, physical activity and exercise: What we know and what we can learn from comorbid disorders. Epilepsy Behav Rep. 2024;27:100682. doi: 10.1016/j.ebr.2024.100682

 

  1. Conway AE, Verdi M, Shaker MS, et al. Beyond confirmed mast cell activation syndrome: Approaching patients with dysautonomia and related conditions. J Allergy Clin Immunol Pract. 2024;12(7):1738-1750. doi: 10.1016/j.jaip.2024.03.019

 

  1. Watson M, Kreuzman J, Zeribi K, et al. The current state of pediatric functional neurological disorder treatment in the United States. Pediatr Neurol. 2024;158:144-155. doi: 10.1016/j.pediatrneurol.2024.06.010.

 

  1. Norcliffe-Kaufmann L, Palma JA, Kaufmann H. Reply: Is postural tachycardia syndrome a psychogenic disorder? Notes on establishing fear conditioning as causal in the postural orthostatic tachycardia syndrome; Patients with POTS fear that data on abnormal haemodynamic physiology have been ignored; and ‘Psychogenic’ POTS: The NYU team misinterprets association as causation. Brain. 2022;145(11):e113-e114. doi: 10.1093/brain/awac349

 

  1. Norcliffe-Kaufmann L, Palma JA, Martinez J, et al. Fear conditioning as a pathogenic mechanism in the postural tachycardia syndrome. Brain. 2022;145(11):3763-3769. doi: 10.1093/brain/awac249

 

  1. Goldstein DS. Is postural tachycardia syndrome a psychogenic disorder? Brain. 2022;145(11):e105-e106. doi: 10.1093/brain/awac345

 

  1. Lambrechts RA, Jacobs B. Notes on establishing fear conditioning as causal in the postural orthostatic tachycardia syndrome. Brain. 2022;145(11):e107-e108. doi: 10.1093/brain/awac346

 

  1. Bourne KM, Raj V, Sheldon RS, Raj SR. Patients with POTS fear that data on abnormal haemodynamic physiology have been ignored. Brain. 2022;145(11):e109-e110. doi: 10.1093/brain/awac347

 

  1. Tuller D, Blitshteyn S, Davies-Payne D, et al. ‘Psychogenic’ POTS: The NYU team misinterprets association as causation. Brain. 2022;145(11):e111-e112. doi: 10.1093/brain/awac348

 

  1. Blitshteyn S, Treisman GJ, Ruhoy IS, et al. Postural orthostatic tachycardia syndrome and other common autonomic disorders are not functional neurologic disorders. Front Neurol. 2024;15:1490744. doi: 10.3389/fneur.2024.1490744

 

  1. Simpson A, Tallur KK, Chin RF, Yong K, Stone J. Autism spectrum disorder in children and young people with FND. J Psychosom Res. 2024l;182:111681. doi: 10.1016/j.jpsychores.2024.111681

 

  1. Owens AP, Mathias CJ, Iodice V. Autonomic dysfunction in autism spectrum disorder. Front Integr Neurosci. 2021;15:787037. doi: 10.3389/fnint.2021.787037

 

  1. Andersen K, Cavanna AE, Szejko N, et al. A critical examination of the clinical diagnosis of functional tic-like behaviors. Mov Disord Clin Pract. 2024;11(9):1065-1071. doi: 10.1002/mdc3.14150

 

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Advanced Neurology, Electronic ISSN: 2810-9619 Print ISSN: 3060-8589, Published by AccScience Publishing
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