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Advanced Neurology

ORIGINAL RESEARCH ARTICLE
Postural orthostatic tachycardia syndrome in

patients with tic disorders and functional tic-like
behaviors

4,5
4,5
4,5
Andrea E. Cavanna 1,2,3,4,5 * , Silvia Chiereghin ,Silvia Ferrari , Giulia Paini ,

4,5
Laura Spini , Giulia Purpura 4 , Anna Riva 4,5 ,and Renata Nacinovich 4,5
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

Abstract

Postural orthostatic tachycardia syndrome (POTS) is an autonomic condition
*Corresponding author: characterized by sustained excessive postural tachycardia, often accompanied by
Andrea E. Cavanna a range of other symptoms of orthostatic intolerance, including heart palpitations,
(a.e.cavanna@bham.ac.uk)
light-headedness, weakness, tremulousness, blurred vision, nausea, headache,
Citation: Cavanna AE, Chiereghin S, dizziness and syncope. POTS predominantly affects young females. Little is known
Ferrari S, et al. Postural orthostatic
tachycardia syndrome in patients about the exact pathophysiology of this condition; however, preliminary reports
with tic disorders and functional about comorbidity profile of POTS suggest a possible link with functional disorders.
tic-like behaviors. Adv Neurol. The striking increase in functional tic-like behaviors (a specific phenotype of functional
2025;4(2):100-111.
doi: 10.36922/an.8525 movement disorder) during the COVID-19 pandemic offered a privileged opportunity
to further explore the possible association between POTS and functional neurological
Received: January 13, 2025 disorder. In the present study, we retrospectively assessed the prevalence of POTS in
Revised: February 25, 2025 two large patient populations from a specialist clinic for tic disorders: (1) patients with
Accepted: March 7, 2025 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
Published online: March 19, 2025 functional tics since the onset of the COVID-19 pandemic (April 2020 – December
Copyright: © 2025 Author(s). 2024). The prevalence of POTS was 0/638 in the GTS group and 4/177 (2.3%) in
This is an Open-Access article the functional tics group. The four patients with POTS were females, with age
distributed under the terms of the
Creative Commons Attribution at assessment ranging from 17 to 24 years. In addition to describing their clinical
License, permitting distribution, characteristics, we discuss the significance of the selective association between POTS
and reproduction in any medium, and functional tic-like behaviors, in the absence of comorbidity between POTS and
provided the original work is
properly cited. neurodevelopmental tics.
Publisher’s Note: AccScience
Publishing remains neutral with Keywords: Postural orthostatic tachycardia syndrome; Tic disorders; Gilles de la Tourette
regard to jurisdictional claims in
published maps and institutional syndrome; Functional tic-like behaviors
affiliations.

Volume 4 Issue 2 (2025) 100 doi: 10.36922/an.8525