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[page 34]                                                       [Emergency Care Journal 2017; 13:6957]

A 15-year-old girl with 
cramping movements
Amanda Spadafora,1,2 
Andrea Andrade,1,2
Rodrick Rodrick Lim1,2

1Departments of Paediatrics and
Medicine, Schulich School of Medicine,
University of Western Ontario;
2Children’s Health Research Institute,
Children’s Hospital, London Health
Sciences Centre, London, Ontario,
Canada

Clinical introduction
A 15-year old, previously healthy

female presented to the emergency depart-
ment with two weeks of mild crampy
abdominal pain lasting approximately 10-
15 seconds associated with abdominal wall
movements which were visible to both the
patient and her mother. There is no correla-
tion of the pain with eating, drinking, bowel
movements or her menses, and no aggravat-
ing or relieving factors. Interestingly, she
has experienced similar symptoms around 2
years ago, and that it resolved spontaneous-
ly after a few weeks. Her past medical and
family history was unremarkable. A video
of these episodes was captured (Video 1).

Question
What is the most likely diagnosis?
A. Hypercalcemia
B. Periodic paralysis
C. Abdominal wall tic
D. Belly dancer’s dyskinesia
E. Psychogenic movement disorder

Answer
The video (Video 1) and clinical history

are most suggestive of an abdominal wall
tic. On further questioning, the patient
revealed that she was able to suppress the
movements for a short time, before the sen-
sation built up and started becoming
uncomfortable. This was consistent with the
classic feeling of inner tension with tic sup-
pression associated with the premonitory
urge preceding the tic.  This made the diag-
nosis of Belly dancer’s dyskinesia unlikely
given the ability to suppress it without hold-
ing her breath. Once the patient was
informed, her mother remembered that she
too had experienced a tic previously (head
turning), which would occur during times of
stress. 

A tic is defined as being a sudden, repet-
itive movement or sound, which is often a
piece of a normal movement performed out-
side of the normal situation/context. Tics
are unique from other movement disorders
in that the patient is able to suppress the
movements, however often only for a limit-
ed period of time, and are common (5% of
children). 

Recognition of unusual tics such as
abdominal wall tics in children is important
to avoid unnecessary investigations and
treatment. As always, clinicians should bal-
ance the age and characteristics of the
patient, any past history consistent with tics
(sniffing, blinking, vocal, etc.), and perti-
nent physical exams to guide the need for
investigations.1-3

References
1. Black KJ, Black ER, Greene DJ,

Schlaggar BL. Provisional tic disorder:
what to tell parents when their child
first starts ticcing. F1000 Research
2016;5:696. 

2. Mack KJ. Tic disorders and their differ-
ential diagnosis in childhood. Pediatr
Child Health 2009;19:235-8.

3. Shin ZH, Jung CH, Kim HC. Follow-up
study of the tic disorders. J Korean
Acad Child Adolesc Psych 1996;7:68-
76.

                             Emergency Care Journal 2017; volume 13:6957

Correspondence: Rodrick Lim, Children’s
Hospital at London Health Sciences Centre,
800 Commissioners Road East, London, ON,
N6C 2V5, Canada.
Tel: 519-685-8134 - Fax: 519-667-6769.
E-mail: Rod.Lim@lhsc.on.ca

Key words: Cramping movements;
Abdominal wall tic; Tic disorders; Children;
Adolescents.

Received for publication: 26 July 2017.
Revision received: 29 August 2017.
Accepted for publication: 30 August 2017.

This work is licensed under a Creative
Commons Attribution 4.0 License (by-nc 4.0).

©Copyright A. Spadafora et al., 2017
Licensee PAGEPress, Italy
Emergency Care Journal 2017; 13:6957
doi:10.4081/ecj.2017.6957