Motor and Vocal Tics
Many kids experience tics in childhood, but a new onset of tics accompanied by other behavioral or psychiatric symptoms, such as ADHD or OCD, can be due to an underlying infection-triggered autoimmune response.

Motor and Vocal Tics
Tic disorders, including Tourette’s syndrome (TS), are characterized by involuntary, abrupt, repetitive movements and/or vocal utterances. Motor tics (excessive eye blinking, eye rolls, facial grimaces, hand gestures) and vocal tics (coughing, throat clearing, spitting, grunting) can wax and wane over time. Tics, which typically surface between the ages of 4 and 6 1, often appear alongside symptoms of OCD and ADHD.
The exact cause of motor and vocal tics is unknown but genetics are believed to play a role. Certain toxins or drugs, brain trauma, alterations in neurotransmitter functioning and changes in certain regions of the brain, along with environmental factors, such as infections can also contribute to the sudden onset of tics.

Infections and sudden onset of tics in a child

Mounting evidence indicates that multiple types of infections (bacterial and viral) can trigger the sudden onset of tics in a child, adolescent or adult. Researchers believe that in some people, common infections trigger an abnormal immune response, which causes antibodies to attack healthy cells in the brain. This autoimmune attack on the brain can cause inflammation and the onset of neuropsychiatric symptoms, including tics.

According to the authors of one study, “Evidence points increasingly toward a role for infection and immune factors in at least a subset of [Tourette’s syndrome].” 2

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Infections triggering motor and vocal tics is not new

The concept of infections triggering motor and vocal tics is not new. In 1929, a case series was published describing three boys who developed tics following surgery for sinusitis. 3 Since then, multiple infectious agents have been linked with tic disorders.

For example, Group A strep infections can cause a sudden onset of tics in a child or adolescent who is genetically susceptible. In these cases, the child’s tics may be the result of a treatable autoimmune disorder known as Pediatric Autoimmune Neuropsychiatric Disorders Associated with Strep infections (PANDAS).

PANDAS is characterized by an abrupt and sudden onset of tics and/or OCD in a child following an infection. It is not rare but often goes unrecognized by many clinicians. In fact, researchers estimate that at least 25% of children and adolescents diagnosed with obsessive-compulsive disorder (OCD) and tic disorders actually have PANDAS. 4

Neurologic tic disorder vs. an infection-induced autoimmune disorder

Making the distinction between a neurologic tic disorder and an infection-induced autoimmune disorder is important, since treatment differs for each.

Furthermore, individuals with chronic tics and/or OCD were found to have elevated levels of several antineuronal antibodies, which were detected using the the Cunningham Panel™. Elevated levels indicate that an infection-triggered autoimmune process may be causing a patient’s neuropsychiatric symptoms, such as tics. 5

A study co-authored by Dr. Madeleine Cunningham found a “significant correlation of streptococcal-associated tics and OCD with elevated anti-D1R and anti-Lysoganglioside antineuronal antibodies in serum concomitant with higher activation of CaMKII in human neuronal cells.” 5

Chronic tics and OCD may have underlying etiology

“Youth and young adults with chronic tics and OCD may have underlying infectious/immunologic etiology,” the authors concluded. 5

Researchers have also found that children who had multiple strep infections were at a greater risk of developing Tourette’s syndrome when compared to those who did not have repeated infections. 6

Watch Video: Study findings evaluating accuracy and sensitivity of the Cunningham Panel of tests for an infection-triggered autoimmune encephalopathy

Other types of infections can trigger a sudden onset of tics in a child. Borrelia burgdorferi (the bacteria causing Lyme disease), mycoplasma pneumoniae, and herpes simplex virus are believed to play a role in the pathogenesis of tic disorders, such as Tourette’s syndrome. 7

Additionally, the enterovirus (EV) has been associated with a greater incidence of tic disorders. 8 “Our observations add to the growing body of literature implicating the immune-inflammatory process as relevant to the pathoetiology of some mental disorders,” reports Tsai and colleagues. 8

  1. American Psychiatric Association. Diagnostic and Statistical Manual of Mental Disorders fifth edition. Washington (DC): American Psychiatric Association; 2013.
  2. Hornig M, Lipkin WI. Immune-mediated animal models of Tourette syndrome. Neurosci Biobehav Rev. 2013;37(6):1120–1138. doi:10.1016/j.neubiorev.2013.01.007
  3. Selling L. The role of infection in the etiology of tics. Arch Neurol Psychiatry. 1929;22:1163–1171.
  4. Westley, Erica. From Throat to Mind. Strep today, anxiety later? Scientific American. Jan. 1, 2010.
  5. Cox CJ, Zuccolo AJ, Edwards EV, et al. Antineuronal antibodies in a heterogeneous group of youth and young adults with tics and obsessive-compulsive disorder. J Child Adolesc Psychopharmacol. 2015;25(1):76–85. doi:10.1089/cap.2014.0048
  6. Mell LK, Davis RL, Owens D. Association between streptococcal infection and obsessive-compulsive disorder, Tourette’s syndrome, and tic disorder. Pediatrics. 2005;116:56–60.
  7. Krause DL, Müller N. The Relationship between Tourette's Syndrome and Infections. Open Neurol J. 2012;6:124–128. doi:10.2174/1874205X01206010124
  8. Tsai CS, Yang YH, Huang KY, Lee Y, McIntyre RS, Chen VC. Association of Tic Disorders and Enterovirus Infection: A Nationwide Population-Based Study. Medicine (Baltimore). 2016;95(15):e3347. doi:10.1097/MD.0000000000003347
Infections can cause a sudden onset of tics in a child.

Infections, such as strep and mycoplasma pneumonia, may trigger an onset of tics.

Infections may result in sudden onset of tics in a child
How can an infection create a sudden onset of tics in a child

Learn more about how infections can trigger neuropsychiatric symptoms

Cunningham Panel helps identify an autoimmune disorder in child initially diagnosed with schizophrenia

The Cunningham Panel™ helped identify an underlying autoimmune disorder in a child initially diagnosed with schizophrenia.

Researchers describe a complex case involving a 15-year-old girl, who abruptly developed multiple neurologic and psychiatric symptoms.

The association between streptococcus pyogenes and tics/OCD

Association between streptococcus pyogenes and tics/OCD

In this book chapter, Dr. Madeleine Cunningham explains the association between Group A strep and the onset of tics and/or OCD and their clinical manifestations in children with the autoimmune neuropsychiatric disorder, PANDAS.

Childhood infections can increase risk of mental illness in kidss

Childhood infections can increase risk of mental illness in kids

Nationwide study finds both mild and severe infections can increase risk of mental disorders in children and adolescents.

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    The Cunningham Panel™ – Antibody testing that helps determine whether an autoimmune response may be triggering neurologic and/or psychiatric symptoms.

B. Robert Mozayeni, MD

Medical and Clinical Advisor

B. Robert Mozayeni MD

Dr. B. Robert Mozayeni was trained in Internal Medicine and Rheumatology at Yale and at NIH. He has had pre- and post-doctoral Fellowships in Molecular Biophysics and Biochemistry at Yale, and also at NIH where he was a Howard Hughes Research Scholar at LMB/DCBD/NCI and later, Senior Staff Fellow at LMMB/NHLBI/NIH. Editorial board of Infectious Diseases – Surveillance, Prevention and Treatment. Past President of the International Lyme and Associated Diseases Society (ILADS).

He is an expert in Translational Medicine, the science and art of advancing medical science safely and efficiently. He is a Fellow of the non-profit Think Lead Innovate Foundation and is a co-founder of the Foundation for the Study of Inflammatory Diseases. He is a Founder of the Foundation for the Study of Inflammatory Diseases to crowd-source medical solutions for complex conditions using existing knowledge, diagnostic methods, and therapies to meet patient needs immediately. He is the Chief Medical Officer of Galaxy Diagnostics, LLC. He is a Board member of the Human-Kind Alliance. Dr. Mozayeni has held admitting privileges (since 1994) on the clinical staff of Suburban Hospital, a member of Johns Hopkins Medicine and an affiliate of the National Institutes of Health Clinical Center.

Safedin Sajo Beqaj, PhD, HCLD, CC (ABB)

Moleculera Labs, Clinical Laboratory Advisor
Medical Database, Inc., President and CEO

Sajo Baqaj, PhD

Dr. Sajo Beqaj is board certified in molecular pathology and genetics and licensed as a Bioanalyst and High Complexity Laboratory Director. He has been practicing as a laboratory director since 2005.

Dr. Beqaj served as a technical director and was part of the initial management team for several well-known laboratories in the clinical lab industry including PathGroup, Nashville, TN; DCL Medical Laboratories, Indianapolis, IN, and Pathology, Inc, Torrance, CA. He is currently serving as off-side CLIA laboratory director for BioCorp Clinical Laboratory, Whittier, CA and Health360 Labs, Garden Grove, CA.

Dr. Beqaj received his Ph.D. in Pathology from Wayne State University Medical School, Detroit, Michigan. He performed his post-doctoral fellowship at Abbott Laboratories from 2001-2003 and with Children’s Hospital and Northwestern University from 2003-2005.

Dr. Beqaj has taught in several academic institutions and has published numerous medical textbook chapters and journal articles. He has served as a principal investigator in clinical trials for several well-known pharmaceutical and diagnostic companies such as Roche HPV Athena, Merck HPV vaccine, BD vaginitis panel, Roche (Vantana) CINtec® Histology clinical trials, and has presented various scientific clinical abstracts and presentations.

He is a member of several medical and scientific associations including the Association of Molecular Pathology, American Association of Clinical Chemistry and the Pan Am Society for Clinical Virology. He has served on a number of clinical laboratory regulatory and scientific committees, and has assisted several laboratories and physicians as a Clinical Laboratory Consultant.

Rodney Cotton, MBA

Moleculera Labs Board Member

Rodney Cotton, MBA

Rodney Cotton, MBA is an entrepreneurial thought leader in the pharmaceutical/biotech industry who is known for his holistic perspective, bias for action in the face of challenges, and commitment to agile processes.

Rod is an independent director for Orchard Software, a private equity-backed health technology company owned by Francisco Partners; an advisory board member to Flo2 Ventures, a venture capital-backed healthcare and health equity accelerator; and a member of the board of directors and three board committees (Audit, Compliance & Finance; Governance & Equity; and Quality of Care) for Community Health Network.

He built a successful career at Roche spanning more than two decades and culminating in the role of SVP, Head of Strategy & Transformation, and Chief of Staff to the CEO for Roche Diagnostics, the North American headquarters of the world’s largest ($17B) diagnostics company.

While at Roche, Rod led key enterprise initiatives, such as milestone corporate communications, health equity coalitions, the US/Roche Group audit, and global/US acquisition integrations. With 40+ years of experience, he drove the financial turnaround and cultural transformation of four global healthcare companies, led teams of up to 280 total reports, managed P&L of more than $1 billion, and served as a key member of the senior leadership team executing the most significant restructuring of the company in two decades.

In the face of the COVID-19 pandemic, Rod and his team at Roche accelerated six ground breaking products in 11 months, including the first launch of the market’s most accurate and in demand molecular diagnostic test. He also solved extraordinary challenges of product scarcity, supply chain, product allocation, and logistics to achieve accelerated global sourcing and self manufacturing in line with testing guidelines.

A frequent public speaker on health equity and other topics, Rod was named one of the Most Influential Black Executives in Corporate America by Savoy Magazine and one of the Top Blacks in Healthcare by He also received The Sagamore of the Wabash Award, one of the highest Indiana State honors, bestowed by Indiana Governor Eric J. Holcomb.

Rod holds an M.B.A. from California State University, Dominguez Hills, an M.S. in Strategic Management from the University of Southern California, and a B.A. in Biological Sciences & Technology from the University of California at Santa Barbara.