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Case Study: Motor Tics: 12-Year-Old Female

Introduction

A 12-year-old female presented to CFNC with a chief complaint of motor tics that began the year prior with no known cause.

Symptoms included involuntary movements of the neck in a side-to-side motion and were impacting the patient’s quality of life. They started gradually and improved somewhat after working with a functional medicine practitioner who did a heavy metal detoxification protocol and a parasite cleanse. After completing the treatments, the motor tic was no longer present in the eyes, but aberrant movement of the cervical spine remained.

Examination and Diagnosis

Physical examination and diagnostic testing revealed impaired dual tasking, L cerebellar dysfunction through evaluation of balance and coordinated movements, and presence of retained primitive reflexes (ATNR and Spinal Galant). Neurological examination revealed involvement of the patient’s bilateral mesencephalon, frontal cortex and left pontomedullary reticular formation.

Treatment

The patient was initially treated two times per week for one hour over five consecutive weeks (nine visits total), with a re-examination on the final visit. After re-examination, the patient was recommended to follow up with two consecutive 30-minute sessions once per month to maintain current progress and check in.

After four months of home rehabilitation exercises, the patient returned for another 60-minute re-evaluation upon suffering a concussion. The patient now checks in monthly to recover from home as she follows recommended neurological exercises and dietary and nutritional recommendations.

Treatment consisted of vestibular rehabilitation and oculomotor exercises, complex movements, an interactive metronome, neurosensorimotor integrator (Go No Go and Saccades), brainstem neuromodulation through RPSS and primitive reflex integration exercises (lizards and snow angels).


Results

After the initial course of treatment, the patient reported improvement with the frequency of the motor tic, such that it only occurred when participating in sports activities. The patient also noticed significant improvement when taking the recommended nutritional supplement (Gabatone). Upon assessment, she was no longer experiencing a convergence spasm in the darkness and showed significant improvement in gaze stability, increased ability to dual task and a full integration of the Spinal Galant reflex. At checkout, the patient was provided with a custom home treatment plan to continue to address the cerebellar dysfunction and was evaluated monthly to track progress.

One month following the re-examination, the patient’s mother reported significant improvement in motor tics and that the patient no longer needed the provided supplement to manage her symptoms. The patient was able to maintain this progress until incurring a concussion while playing sports.

Six weeks post-concussion, the patient reported that the home exercises and supplements were helpful and that she was feeling better. Symptoms such as vocal changes had stopped, and she was not experiencing any motor tics.

Conclusion

Functional neurological care and functional medicine have been shown to be effective in treating motor tic and post-concussion syndrome. Patients require an individualized approach and targeted treatment to achieve optimal results.

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