A survey of 47 women with Tourette syndrome reported from the Section of Pediatric Neurology, Children’s Hospital of Wisconsin, Milwaukee, WI had an increase in tics beginning at menarche and recurring premenstrually. A comparable number of patients had a decreased tic frequency during the postmenstrual period. The average age of symptom onset was 8 years and the average age of diagnosis was 13.8 years. No significant relationship was found between a change in tic frequency and other non-menstrual cycle-related female hormonal states such as premenstrual syndrome, oral contraceptive use, pregnancy and menopause. [1]

COMMENT. Thermal stress is another factor that might exacerbate Tourette syndrome and cause an increase in the frequency of tics [2]. When challenged with heat or exercise in climate controlled conditions a 17 year old boy showed a marked increase in frequency of tics. The patient reported that his tics became more severe whenever the weather became warmer, when he had a fever, or after vigorous exercise. He would have difficulty standing and often had to lie down because of the severity of head jerks and other tics.