Letter to the Editor
Pollakiuria as a complex motor tic in a patient with Tourette syndrome
Polaquiuria como tic motor complejo en un paciente con síndrome de Tourette
Unidad de Trastornos del Movimiento, Servicio de Neurología, Hospital Clínico San Carlos, Universidad Complutense de Madrid, Madrid, Spain
Read
12018
Timeswas read the article
974
Total PDF
11044
Total HTML
Share statistics
array:25 [ "pii" => "S2173580819300197" "issn" => "21735808" "doi" => "10.1016/j.nrleng.2017.02.013" "estado" => "S300" "fechaPublicacion" => "2020-01-01" "aid" => "1058" "copyright" => "Sociedad Española de Neurología" "copyrightAnyo" => "2017" "documento" => "simple-article" "crossmark" => 1 "licencia" => "http://creativecommons.org/licenses/by-nc-nd/4.0/" "subdocumento" => "cor" "cita" => "Neurologia. 2020;35:46-7" "abierto" => array:3 [ "ES" => true "ES2" => true "LATM" => true ] "gratuito" => true "lecturas" => array:2 [ "total" => 605 "formatos" => array:3 [ "EPUB" => 31 "HTML" => 480 "PDF" => 94 ] ] "Traduccion" => array:1 [ "es" => array:20 [ "pii" => "S0213485317301524" "issn" => "02134853" "doi" => "10.1016/j.nrl.2017.02.014" "estado" => "S300" "fechaPublicacion" => "2020-01-01" "aid" => "1058" "copyright" => "Sociedad Española de Neurología" "documento" => "simple-article" "crossmark" => 1 "licencia" => "http://creativecommons.org/licenses/by-nc-nd/4.0/" "subdocumento" => "cor" "cita" => "Neurologia. 2020;35:46-7" "abierto" => array:3 [ "ES" => true "ES2" => true "LATM" => true ] "gratuito" => true "lecturas" => array:2 [ "total" => 869 "formatos" => array:3 [ "EPUB" => 53 "HTML" => 509 "PDF" => 307 ] ] "es" => array:10 [ "idiomaDefecto" => true "cabecera" => "<span class="elsevierStyleTextfn">Carta al Editor</span>" "titulo" => "Polaquiuria como tic motor complejo en un paciente con síndrome de Tourette" "tienePdf" => "es" "tieneTextoCompleto" => "es" "paginas" => array:1 [ 0 => array:2 [ "paginaInicial" => "46" "paginaFinal" => "47" ] ] "titulosAlternativos" => array:1 [ "en" => array:1 [ "titulo" => "Pollakiuria as a complex motor tic in a patient with Tourette syndrome" ] ] "contieneTextoCompleto" => array:1 [ "es" => true ] "contienePdf" => array:1 [ "es" => true ] "autores" => array:1 [ 0 => array:2 [ "autoresLista" => "R. García-Ramos, E. López Valdés" "autores" => array:2 [ 0 => array:2 [ "nombre" => "R." "apellidos" => "García-Ramos" ] 1 => array:2 [ "nombre" => "E." "apellidos" => "López Valdés" ] ] ] ] ] "idiomaDefecto" => "es" "Traduccion" => array:1 [ "en" => array:9 [ "pii" => "S2173580819300197" "doi" => "10.1016/j.nrleng.2017.02.013" "estado" => "S300" "subdocumento" => "" "abierto" => array:3 [ "ES" => true "ES2" => true "LATM" => true ] "gratuito" => true "lecturas" => array:1 [ "total" => 0 ] "idiomaDefecto" => "en" "EPUB" => "https://multimedia.elsevier.es/PublicationsMultimediaV1/item/epub/S2173580819300197?idApp=UINPBA00004N" ] ] "EPUB" => "https://multimedia.elsevier.es/PublicationsMultimediaV1/item/epub/S0213485317301524?idApp=UINPBA00004N" "url" => "/02134853/0000003500000001/v1_202003180804/S0213485317301524/v1_202003180804/es/main.assets" ] ] "itemSiguiente" => array:19 [ "pii" => "S217358081930029X" "issn" => "21735808" "doi" => "10.1016/j.nrleng.2019.02.006" "estado" => "S300" "fechaPublicacion" => "2020-01-01" "aid" => "1086" "documento" => "simple-article" "crossmark" => 1 "licencia" => "http://creativecommons.org/licenses/by-nc-nd/4.0/" "subdocumento" => "cor" "cita" => "Neurologia. 2020;35:47-9" "abierto" => array:3 [ "ES" => true "ES2" => true "LATM" => true ] "gratuito" => true "lecturas" => array:2 [ "total" => 181 "formatos" => array:3 [ "EPUB" => 36 "HTML" => 84 "PDF" => 61 ] ] "en" => array:11 [ "idiomaDefecto" => true "cabecera" => "<span class="elsevierStyleTextfn">Letter to the Editor</span>" "titulo" => "Scurvy and Wernicke's encephalopathy: An underdiagnosed association?" "tienePdf" => "en" "tieneTextoCompleto" => "en" "paginas" => array:1 [ 0 => array:2 [ "paginaInicial" => "47" "paginaFinal" => "49" ] ] "titulosAlternativos" => array:1 [ "es" => array:1 [ "titulo" => "Encefalopatía de Wernicke-escorbuto, ¿una asociación infradiagnosticada?" ] ] "contieneTextoCompleto" => array:1 [ "en" => true ] "contienePdf" => array:1 [ "en" => true ] "resumenGrafico" => array:2 [ "original" => 0 "multimedia" => array:7 [ "identificador" => "fig0010" "etiqueta" => "Figure 2" "tipo" => "MULTIMEDIAFIGURA" "mostrarFloat" => true "mostrarDisplay" => false "figura" => array:1 [ 0 => array:4 [ "imagen" => "gr2.jpeg" "Alto" => 1050 "Ancho" => 1400 "Tamanyo" => 129133 ] ] "descripcion" => array:1 [ "en" => "<p id="spar0010" class="elsevierStyleSimplePara elsevierViewall">(A) Gingivitis and teeth deformities. (B) Dermoscopic image of a corkscrew hair. (C) Dermoscopic image of follicular purpura.</p>" ] ] ] "autores" => array:1 [ 0 => array:2 [ "autoresLista" => "J. Villacieros-Álvarez, P. Chicharro, S. Trillo, A. Barbosa" "autores" => array:4 [ 0 => array:2 [ "nombre" => "J." "apellidos" => "Villacieros-Álvarez" ] 1 => array:2 [ "nombre" => "P." "apellidos" => "Chicharro" ] 2 => array:2 [ "nombre" => "S." "apellidos" => "Trillo" ] 3 => array:2 [ "nombre" => "A." "apellidos" => "Barbosa" ] ] ] ] ] "idiomaDefecto" => "en" "Traduccion" => array:1 [ "es" => array:9 [ "pii" => "S0213485317302256" "doi" => "10.1016/j.nrl.2017.05.011" "estado" => "S300" "subdocumento" => "" "abierto" => array:3 [ "ES" => true "ES2" => true "LATM" => true ] "gratuito" => true "lecturas" => array:1 [ "total" => 0 ] "idiomaDefecto" => "es" "EPUB" => "https://multimedia.elsevier.es/PublicationsMultimediaV1/item/epub/S0213485317302256?idApp=UINPBA00004N" ] ] "EPUB" => "https://multimedia.elsevier.es/PublicationsMultimediaV1/item/epub/S217358081930029X?idApp=UINPBA00004N" "url" => "/21735808/0000003500000001/v1_202004040635/S217358081930029X/v1_202004040635/en/main.assets" ] "itemAnterior" => array:20 [ "pii" => "S2173580819300598" "issn" => "21735808" "doi" => "10.1016/j.nrleng.2017.05.005" "estado" => "S300" "fechaPublicacion" => "2020-01-01" "aid" => "1091" "copyright" => "Sociedad Española de Neurología" "documento" => "article" "crossmark" => 1 "licencia" => "http://creativecommons.org/licenses/by-nc-nd/4.0/" "subdocumento" => "rev" "cita" => "Neurologia. 2020;35:40-5" "abierto" => array:3 [ "ES" => true "ES2" => true "LATM" => true ] "gratuito" => true "lecturas" => array:2 [ "total" => 104 "formatos" => array:2 [ "EPUB" => 25 "PDF" => 79 ] ] "en" => array:12 [ "idiomaDefecto" => true "cabecera" => "<span class="elsevierStyleTextfn">Review</span>" "titulo" => "Early electrophysiological findings in Fisher-Bickerstaff syndrome" "tienePdf" => "en" "tieneTextoCompleto" => "en" "tieneResumen" => array:2 [ 0 => "en" 1 => "es" ] "paginas" => array:1 [ 0 => array:2 [ "paginaInicial" => "40" "paginaFinal" => "45" ] ] "titulosAlternativos" => array:1 [ "es" => array:1 [ "titulo" => "Hallazgos electrofisiológicos precoces en síndrome Fisher-Bickerstaff" ] ] "contieneResumen" => array:2 [ "en" => true "es" => true ] "contieneTextoCompleto" => array:1 [ "en" => true ] "contienePdf" => array:1 [ "en" => true ] "autores" => array:1 [ 0 => array:2 [ "autoresLista" => "M.A. Alberti, M. Povedano, J. Montero, C. Casasnovas" "autores" => array:4 [ 0 => array:2 [ "nombre" => "M.A." "apellidos" => "Alberti" ] 1 => array:2 [ "nombre" => "M." "apellidos" => "Povedano" ] 2 => array:2 [ "nombre" => "J." "apellidos" => "Montero" ] 3 => array:2 [ "nombre" => "C." "apellidos" => "Casasnovas" ] ] ] ] ] "idiomaDefecto" => "en" "Traduccion" => array:1 [ "es" => array:9 [ "pii" => "S0213485317302414" "doi" => "10.1016/j.nrl.2017.05.012" "estado" => "S300" "subdocumento" => "" "abierto" => array:3 [ "ES" => true "ES2" => true "LATM" => true ] "gratuito" => true "lecturas" => array:1 [ "total" => 0 ] "idiomaDefecto" => "es" "EPUB" => "https://multimedia.elsevier.es/PublicationsMultimediaV1/item/epub/S0213485317302414?idApp=UINPBA00004N" ] ] "EPUB" => "https://multimedia.elsevier.es/PublicationsMultimediaV1/item/epub/S2173580819300598?idApp=UINPBA00004N" "url" => "/21735808/0000003500000001/v1_202004040635/S2173580819300598/v1_202004040635/en/main.assets" ] "en" => array:13 [ "idiomaDefecto" => true "cabecera" => "<span class="elsevierStyleTextfn">Letter to the Editor</span>" "titulo" => "Pollakiuria as a complex motor tic in a patient with Tourette syndrome" "tieneTextoCompleto" => true "saludo" => "Dear Editor," "paginas" => array:1 [ 0 => array:2 [ "paginaInicial" => "46" "paginaFinal" => "47" ] ] "autores" => array:1 [ 0 => array:4 [ "autoresLista" => "R. García-Ramos, E. López Valdés" "autores" => array:2 [ 0 => array:4 [ "nombre" => "R." "apellidos" => "García-Ramos" "email" => array:1 [ 0 => "garciaramosg@yahoo.es" ] "referencia" => array:1 [ 0 => array:2 [ "etiqueta" => "<span class="elsevierStyleSup">*</span>" "identificador" => "cor0005" ] ] ] 1 => array:2 [ "nombre" => "E." "apellidos" => "López Valdés" ] ] "afiliaciones" => array:1 [ 0 => array:2 [ "entidad" => "Unidad de Trastornos del Movimiento, Servicio de Neurología, Hospital Clínico San Carlos, Universidad Complutense de Madrid, Madrid, Spain" "identificador" => "aff0005" ] ] "correspondencia" => array:1 [ 0 => array:3 [ "identificador" => "cor0005" "etiqueta" => "⁎" "correspondencia" => "Corresponding author." ] ] ] ] "titulosAlternativos" => array:1 [ "es" => array:1 [ "titulo" => "Polaquiuria como tic motor complejo en un paciente con síndrome de Tourette" ] ] "textoCompleto" => "<span class="elsevierStyleSections"><p id="par0005" class="elsevierStylePara elsevierViewall">Tourette syndrome (TS) is a condition with onset in childhood, characterised by motor and phonic tics, and such associated psychiatric disorders as obsessive-compulsive disorder (OCD) and attention-deficit/hyperactivity disorder; patients with TS present a wide variety of phenotypes. It is believed to be caused by a dysfunction of different cortical circuits, especially in the fronto-parietal cortex and basal ganglia, which explains the clinical heterogeneity of the syndrome. The current theory is that TS is caused by alterations in the brain's development and maturation.<a class="elsevierStyleCrossRef" href="#bib0005"><span class="elsevierStyleSup">1</span></a> Pollakiuria is defined as an abnormal urinary frequency, and has occasionally been described as a tic in children with TS or paediatric autoimmune neuropsychiatric disorders associated with streptococcus.<a class="elsevierStyleCrossRef" href="#bib0010"><span class="elsevierStyleSup">2</span></a> There are no reported cases of pollakiuria in adults diagnosed with TS. We describe an adult case of TS and pollakiuria.</p><p id="par0010" class="elsevierStylePara elsevierViewall">Our patient was a 46-year-old man with OCD, hypothyrodism, and TS diagnosed according to the DSM-IV criteria since childhood, with simple and complex motor and phonic tics. He responded well to tetrabenazine (125<span class="elsevierStyleHsp" style=""></span>mg/day). He had been treated for depression or anxiety disorder by the psychiatry department; at some point during this treatment, he presented benzodiazepine overuse. In January 2012, as he presented good emotional control and no tics, the patient himself decided to progressively discontinue all medication (tetrabenazine at 125<span class="elsevierStyleHsp" style=""></span>mg/day and dipotassium clorazepate at 30<span class="elsevierStyleHsp" style=""></span>mg/day). In November 2012, he consulted due to a history of pollakiuria of several months’ duration, reporting a urinary frequency of up to 50 times a day, which incapacitated him. The patient reported perineal and left inguinal pain, which was alleviated when he urinated. Pain was diffuse, dull, of short duration, and paroxysmal, and was exacerbated by sitting. The symptoms incapacitated him fully, preventing him from going outdoors or living independently. He reported no symptoms suggesting depression or anxiety recurrence. Months before his follow-up appointment, he had already consulted with the urology department, which requested the following tests: lumbar MRI scan, urinary tract and abdomen and pelvis ultrasounds, cystography, urine culture, blood analysis, urodynamic study, and EMG of the pelvic wall; all tests yielded normal results. At the time of consultation, he reported having used antimuscarinic drugs with no benefits. The neurological examination identified no abnormalities. This was a case of pollakiuria as a response to several months’ history of genital pain with no bladder, prostate, or genital lesion. Since no alterations were found in the neurological examination, lumbar MRI scan, or EMG, we also ruled out lumbosacral neuromuscular disease. Considering the reported symptoms, we considered the possibility of a motor tic or compulsion. We believed the pain to be a premonitory sensation and urination to be the motor pattern alleviating pain; therefore, our initial diagnostic hypothesis was a complex motor tic, to be treated with aripiprazole at 10<span class="elsevierStyleHsp" style=""></span>mg/day. One month after treatment onset, the patient was asymptomatic and reported no adverse effects.</p><p id="par0015" class="elsevierStylePara elsevierViewall">Obsessive-compulsive disorder, or anakastic personality disorder, shares many features with TS: both mainly affect young patients, present a remitting course and premonitory sensation prior to motor tic, and may be associated with complex motor rituals. Between 25% and 50% of patients with TS present OCD and 20%–30% of OCD patients have tics. Therefore, in a patient with TS presenting complex motor rituals, a differential diagnosis of tics and compulsion should be performed.<a class="elsevierStyleCrossRef" href="#bib0015"><span class="elsevierStyleSup">3</span></a> The function of compulsion is to alleviate an obsession or the anxiety caused by an unpleasant intrusive thought. However, tics involve a premonitory sensation which can be defined as a sense of urgency to perform the movement, although it may also be a physical symptom localised in the area where the tic occurs. In our patient, the genital pain, alleviated by urination, may be considered the premonitory sensation that appears by definition before the tic. Urinating would be the complex motor tic.</p><p id="par0020" class="elsevierStylePara elsevierViewall">Interoception is the capacity to perceive sensations originating in the internal organs of the body. Increased perception of the need to urinate may also be considered as heightened interoception in our patient. Increased interoceptive capacity has been related to increased perception of the premonitory sensation of tics, which in turn has been associated with more severe tics.<a class="elsevierStyleCrossRef" href="#bib0005"><span class="elsevierStyleSup">1</span></a> Our patient's pollakiuria may be considered a severe complex motor tic causing a significant limitation to his daily life.</p><p id="par0025" class="elsevierStylePara elsevierViewall">It is important to identify the symptoms of patients displaying complex motor rituals in order to select an appropriate therapeutic approach, since compulsion and tic require different treatments. Aripiprazole is a well-tolerated drug which achieves adequate control of tics.<a class="elsevierStyleCrossRef" href="#bib0020"><span class="elsevierStyleSup">4</span></a></p><p id="par0030" class="elsevierStylePara elsevierViewall">Pollakiuria in an adult patient with TS should raise suspicion of the possibility of a complex motor tic, which would require an adjustment of the therapeutic approach.</p></span>" "pdfFichero" => "main.pdf" "tienePdf" => true "NotaPie" => array:2 [ 0 => array:2 [ "etiqueta" => "☆" "nota" => "<p class="elsevierStyleNotepara" id="npar0005">Please cite this article as: García-Ramos R, López Valdés E. Polaquiuria como tic motor complejo en un paciente con síndrome de Tourette. Neurología. 2020;35:46–47.</p>" ] 1 => array:2 [ "etiqueta" => "☆☆" "nota" => "<p class="elsevierStyleNotepara" id="npar0010">This study was presented in poster format at the 2013 Annual Meeting of the SEN.</p>" ] ] "bibliografia" => array:2 [ "titulo" => "References" "seccion" => array:1 [ 0 => array:2 [ "identificador" => "bibs0015" "bibliografiaReferencia" => array:4 [ 0 => array:3 [ "identificador" => "bib0005" "etiqueta" => "1" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Tics and Tourette's: Update on pathophysiology and tic control" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:1 [ 0 => "C. Ganos" ] ] ] ] ] "host" => array:1 [ 0 => array:2 [ "doi" => "10.1097/WCO.0000000000000356" "Revista" => array:6 [ "tituloSerie" => "Curr Opin Neurol" "fecha" => "2016" "volumen" => "29" "paginaInicial" => "513" "paginaFinal" => "518" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/27310537" "web" => "Medline" ] ] ] ] ] ] ] ] 1 => array:3 [ "identificador" => "bib0010" "etiqueta" => "2" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Pollakiuria in children with tic disorders" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:3 [ 0 => "H.S. Wang" 1 => "H.L. Chang" 2 => "S.W. Chang" ] ] ] ] ] "host" => array:1 [ 0 => array:1 [ "Revista" => array:6 [ "tituloSerie" => "Chang Gung Med J" "fecha" => "2005" "volumen" => "28" "paginaInicial" => "773" "paginaFinal" => "778" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/16422183" "web" => "Medline" ] ] ] ] ] ] ] ] 2 => array:3 [ "identificador" => "bib0015" "etiqueta" => "3" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Repetitive behaviours in patients with Gilles de la Tourette syndrome: Tics, compulsions, or both?" "autores" => array:1 [ 0 => array:2 [ "etal" => true "autores" => array:6 [ 0 => "Y. Worbe" 1 => "L. Mallet" 2 => "J.L. Golmard" 3 => "C. Béhar" 4 => "F. Durif" 5 => "I. Jalenques" ] ] ] ] ] "host" => array:1 [ 0 => array:2 [ "doi" => "10.1371/journal.pone.0012959" "Revista" => array:5 [ "tituloSerie" => "PLoS ONE" "fecha" => "2010" "volumen" => "5" "paginaInicial" => "e12959" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/20885982" "web" => "Medline" ] ] ] ] ] ] ] ] 3 => array:3 [ "identificador" => "bib0020" "etiqueta" => "4" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Aripiprazole for Tourette's syndrome: a systematic review and meta-analysis" "autores" => array:1 [ 0 => array:2 [ "etal" => true "autores" => array:6 [ 0 => "W. Zheng" 1 => "X.B. Li" 2 => "Y.Q. Xiang" 3 => "B.L. Zhong" 4 => "H.F. Chiu" 5 => "G.S. Ungvari" ] ] ] ] ] "host" => array:1 [ 0 => array:2 [ "doi" => "10.1002/hup.2498" "Revista" => array:6 [ "tituloSerie" => "Hum Psychopharmacol" "fecha" => "2016" "volumen" => "31" "paginaInicial" => "11" "paginaFinal" => "18" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/26310194" "web" => "Medline" ] ] ] ] ] ] ] ] ] ] ] ] ] "idiomaDefecto" => "en" "url" => "/21735808/0000003500000001/v1_202004040635/S2173580819300197/v1_202004040635/en/main.assets" "Apartado" => array:4 [ "identificador" => "9409" "tipo" => "SECCION" "en" => array:2 [ "titulo" => "Letters to the editor" "idiomaDefecto" => true ] "idiomaDefecto" => "en" ] "PDF" => "https://static.elsevier.es/multimedia/21735808/0000003500000001/v1_202004040635/S2173580819300197/v1_202004040635/en/main.pdf?idApp=UINPBA00004N&text.app=https://www.elsevier.es/" "EPUB" => "https://multimedia.elsevier.es/PublicationsMultimediaV1/item/epub/S2173580819300197?idApp=UINPBA00004N" ]
| Year/Month | Html | Total | |
|---|---|---|---|
| 2024 November | 127 | 3 | 130 |
| 2024 October | 308 | 13 | 321 |
| 2024 September | 321 | 19 | 340 |
| 2024 August | 215 | 22 | 237 |
| 2024 July | 228 | 15 | 243 |
| 2024 June | 199 | 13 | 212 |
| 2024 May | 248 | 20 | 268 |
| 2024 April | 184 | 8 | 192 |
| 2024 March | 267 | 18 | 285 |
| 2024 February | 203 | 24 | 227 |
| 2024 January | 308 | 20 | 328 |
| 2023 December | 269 | 16 | 285 |
| 2023 November | 241 | 9 | 250 |
| 2023 October | 334 | 14 | 348 |
| 2023 September | 178 | 9 | 187 |
| 2023 August | 230 | 7 | 237 |
| 2023 July | 274 | 7 | 281 |
| 2023 June | 186 | 14 | 200 |
| 2023 May | 253 | 21 | 274 |
| 2023 April | 212 | 12 | 224 |
| 2023 March | 171 | 12 | 183 |
| 2023 February | 149 | 23 | 172 |
| 2023 January | 146 | 11 | 157 |
| 2022 December | 137 | 13 | 150 |
| 2022 November | 157 | 20 | 177 |
| 2022 October | 140 | 14 | 154 |
| 2022 September | 197 | 10 | 207 |
| 2022 August | 140 | 14 | 154 |
| 2022 July | 192 | 19 | 211 |
| 2022 June | 152 | 14 | 166 |
| 2022 May | 163 | 16 | 179 |
| 2022 April | 212 | 17 | 229 |
| 2022 March | 181 | 17 | 198 |
| 2022 February | 212 | 12 | 224 |
| 2022 January | 149 | 14 | 163 |
| 2021 December | 103 | 9 | 112 |
| 2021 November | 147 | 18 | 165 |
| 2021 October | 198 | 34 | 232 |
| 2021 September | 131 | 27 | 158 |
| 2021 August | 127 | 21 | 148 |
| 2021 July | 160 | 19 | 179 |
| 2021 June | 105 | 12 | 117 |
| 2021 May | 144 | 13 | 157 |
| 2021 April | 516 | 48 | 564 |
| 2021 March | 351 | 15 | 366 |
| 2021 February | 207 | 12 | 219 |
| 2021 January | 180 | 26 | 206 |
| 2020 December | 172 | 13 | 185 |
| 2020 November | 155 | 23 | 178 |
| 2020 October | 119 | 10 | 129 |
| 2020 September | 107 | 14 | 121 |
| 2020 August | 93 | 9 | 102 |
| 2020 July | 130 | 12 | 142 |
| 2020 June | 86 | 5 | 91 |
| 2020 May | 17 | 10 | 27 |
| 2020 April | 16 | 12 | 28 |
| 2020 March | 10 | 6 | 16 |
| 2020 February | 12 | 5 | 17 |
| 2020 January | 16 | 7 | 23 |
| 2019 December | 51 | 8 | 59 |
| 2019 November | 94 | 14 | 108 |
| 2019 October | 50 | 3 | 53 |
| 2019 September | 85 | 1 | 86 |
| 2019 August | 10 | 0 | 10 |
| 2019 July | 18 | 11 | 29 |
| 2019 June | 53 | 20 | 73 |
| 2019 May | 68 | 26 | 94 |
| 2019 April | 25 | 0 | 25 |
| 2019 March | 5 | 1 | 6 |
Show all
