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Tourette syndrome with clonic and dystonic tics and vocalizations

This 18-year-old woman has longstanding motor and phonic tics. Examination shows motor tics in the arms, especially repetitive, rotatory movements of the scapula, a very typical dystonic tic. She also displays stereotypic movements of the hands and loud vocalizations. EMG shows short-duration bursts (shorter than 100 ms) consistent with clonic tics and longer duration bursts (longer than 100 ms) consistent with dystonic or tonic tics. (Contributed by Dr. Joseph Jankovic.)