A comprehensive clinical examination is the basis for selecting further diagnostic steps:
- General physical examination – including blood pressure, pulse, body weight, height; further:
- Inspection (viewing).
- Head and face to determine motor and vocal tics occurring in type, frequency, intensity, complexity
- Entire body [motor tics]
- Inspection (viewing).
- Neurological examination[due todifferential diagnoses:
- Huntington’s chorea (synonyms: Huntington’s chorea or Huntington’s disease; older name: St. Vitus’ dance) – genetic disorder with autosomal dominant inheritance characterized by involuntary, uncoordinated movements accompanied by flaccid muscle tone; as a result, problems with eating occur, among other symptoms; may be accompanied by tics (secondary tics) (rare)
- Chorea minor (chorea Sydenham) – late manifestation of rheumatic fever (weeks to months) with involvement of the corpus striatum (part of the basal ganglia, which belong to the cerebrum); occurring almost exclusively in children; leads to hyperkineses (lightning-like movements), muscle hypotonia and mental changes; may be accompanied by tics (secondary tics) (rare)
- Dissociative movement disorders – loss of ability to move or disturbance of movement patterns.
- Dystonia – disturbance of the state of tension of the musculature, unspecified.
- Focal epileptic seizures
- Myoclonia – brief, involuntary twitching of single muscles/groups of muscles.
- Neuroacanthocytoses (Huntington disease like 2, autosomal recessive chorea-acanthocytosis, McLeod syndrome); may be associated with tics (secondary tics) (rare)
- Restless Legs Syndrome (RLS) – insensations mostly in the lower extremities and associated urge to move (motor restlessness).
- Spasm hemifacialis – spasm of the part of the facial muscles supplied by the facial nerve.
- Stereotypies – simple or complex action in speech and/or motor skills]
- Psychiatric examination[due tocomorbidities (concomitant diseases):
- Anxiety disorders
- Attention-deficit/hyperactivity disorder (ADHD).
- Autoaggression
- Depression
- Obsessive-compulsive disorder]
[due todifferential diagnoses:
- Hyperactivity
- Mannerisms – bizarre-looking movement patterns that are most common in schizophrenic disorders
- Obsessive-compulsive disorder]
[due topossible sequelae:
- Anxiety disorders
- Depression
- Social phobia
- Decreased self-esteem]
- Health check
Square brackets [ ] indicate possible pathological (pathological) physical findings.