Resistance pathways and next-generation treatments in chronic lymphocytic leukemia.

Tic disorders (TD) are common neurodevelopmental conditions characterized by sudden, rapid, recurrent, non-rhythmic movements or vocalizations with onset in childhood. The Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition (DSM-5) differentiates between provisional tic disorders (PTD), chronic tic disorders (CTD), and Tourette syndrome (TS); however, defining these disorders as a spectrum (listed from least to most severe) has been proposed. Epidemiological estimates indicate that PTD affects approximately 1.2% of school-aged children in China, with CTD and TS affecting 0.9% and 0.4%, respectively. If PTD progresses to a chronic form, it can adversely affect long-term outcomes in multiple domains, such as educational attainment, social functioning, and quality of life. Therefore, investigating the prognosis of PTD is essential for understanding the progression of the entire TD spectrum. Traditionally, PTD was considered to have a favorable prognosis, with symptoms often remitting spontaneously within months. However, this view is being re-examined. Recent prospective studies suggest that a substantial proportion of children—60% or more—continue to experience tics one year after onset, progressing to CTD or TS. This evolving prognostic understanding presents a central clinical challenge. Parents are understandably concerned about whether tics will persist, yet clinicians—primary care pediatricians, developmental‑behavioral pediatricians, child neurologists, or child psychiatrists—lack reliable, individualized tools to identify which children with newly diagnosed PTD will progress to chronic forms requiring long-term management. A uniform “watchful waiting” approach may delay intervention for high-risk individuals, whereas proactively treating all children would lead to inefficient resource use and unnecessary burden for low-risk families. Consequently, a practical tool to predict prognosis at the PTD stage is important for enabling risk-stratified management and optimizing clinical decision-making. Although several factors—such as tic severity, illness duration, tic complexity, comorbidities [e.g., Attention-Deficit/Hyperactivity Disorder (ADHD), anxiety, Obsessive-Compulsive Disorder (OCD)], adverse perinatal events, and family history of TD—have been linked to PTD prognosis, clinical prediction models specifically developed and prospectively validated in newly diagnosed PTD cohorts remain scarce. Moreover, existing models often focus on statistical performance without addressing the pivotal clinical question of actionable risk thresholds. A further feasibility gap concerns assessment tools. While the Yale Global Tic Severity Scale (YGTSS) is considered a gold-standard assessment, its time-consuming nature limits utility in busy clinical settings. In contrast, brief parent-reported instruments such as the Parent Tic Questionnaire (PTQ) are more feasible for widespread screening and routine follow-up, yet systematic efforts to build and validate PTQ-based prediction models are lacking.