Can Electronic Health Records Help Identify Tic Disorders?

What you need to know

• Researchers analyzed electronic health records to identify common features of tic disorders
• They found tic disorders frequently co-occur with other neuropsychiatric conditions like ADHD, OCD, and anxiety
• A scoring system was developed to help identify potential tic disorder cases based on these common features

Using Electronic Health Records to Study Tic Disorders

Tic disorders, including Tourette syndrome, are complex neurological conditions that affect up to 2% of children. They are characterized by sudden, repetitive movements or sounds called tics. While we know tic disorders have a genetic component, the underlying causes are still not well understood. This is partly because it can be challenging to study large groups of people with tic disorders.

To address this challenge, researchers at Vanderbilt University Medical Center and other institutions developed an innovative approach using electronic health records (EHRs). EHRs contain a wealth of information about patients’ medical histories, diagnoses, and treatments. By analyzing this data, the researchers aimed to better understand the complex features of tic disorders and potentially identify more cases for future studies.

Identifying Common Features of Tic Disorders

The researchers first identified 1,406 individuals with tic disorder diagnoses in their medical records. They compared these patients to 7,030 controls without tic disorders who were matched for age and sex.

Using a method called a phenome-wide association study (PheWAS), they looked for other medical conditions that occurred more frequently in the tic disorder group. This analysis revealed 69 conditions that were significantly associated with having a tic disorder diagnosis.

As expected, many of these associated conditions were other neuropsychiatric disorders, including:

• Anxiety disorders
• Attention-deficit/hyperactivity disorder (ADHD)
• Autism spectrum disorder
• Obsessive-compulsive disorder (OCD)
• Mood disorders
• Depression

The strongest association was with a broad category called “pediatric neuropsychiatric disorders,” which includes conditions like autism and ADHD. This aligns with previous research showing tic disorders frequently co-occur with other neurodevelopmental conditions.

Understanding the Complex Picture of Tic Disorders

The results paint a picture of tic disorders as complex conditions that often involve more than just tics. In fact, the study found that 85.6% of individuals with tic disorders had at least one additional neuropsychiatric diagnosis. Over half (51.9%) had two or more additional diagnoses.

This high rate of co-occurring conditions, or comorbidities, has important implications for both research and clinical care. For researchers, it suggests that studying tic disorders in isolation may miss important aspects of patients’ experiences. For healthcare providers, it highlights the need to screen for and monitor other conditions in patients with tic disorders.

Interestingly, the study found that in most cases (64%), the tic disorder was diagnosed before other neuropsychiatric conditions. This suggests that early identification of tics could help predict and potentially prevent or manage other conditions that may develop later.

Developing a Scoring System for Tic Disorders

Using the information from their analysis, the researchers developed a scoring system called a phenotype risk score (PheRS) for tic disorders. This score is based on how many of the 69 associated conditions an individual has in their medical record.

To test the scoring system, they applied it to a separate group of 90,051 individuals in their medical database. They found that people with clinically confirmed tic disorders had significantly higher scores than those without tic diagnoses.

This scoring system could be a valuable tool for researchers and clinicians. It could help identify individuals who may have undiagnosed tic disorders or who are at higher risk of developing tics. It could also be used to find more participants for future studies on tic disorders.

Limitations and Future Directions

While this study demonstrates the potential of using electronic health records to study tic disorders, it’s important to note some limitations:

• The data comes from a single medical center and may not be representative of all populations.
• Relying on medical records means some conditions may be missed if they weren’t formally diagnosed or recorded.
• The scoring system needs further validation in other populations and settings.

Despite these limitations, this research opens up exciting possibilities for studying tic disorders and other complex neuropsychiatric conditions. By leveraging the vast amount of data in electronic health records, researchers can gain new insights into these disorders and potentially improve diagnosis and treatment.

Conclusions

• Tic disorders frequently co-occur with other neuropsychiatric conditions, particularly ADHD, OCD, and anxiety disorders.
• Analyzing electronic health records can reveal important patterns in how tic disorders present and develop over time.
• A scoring system based on associated conditions could help identify potential tic disorder cases, but needs further validation.