Author(s)
Nikita Kohli, MD
Andrew Blitzer, MD DDS FACS
Affiliation(s)
New York Center for Voice and Swallowing Disorders
Abstract:
Background: Motor and phonic tics are treated with neuroleptic agents or BoNT. Data regarding BoNT treatment is scarce and has yielded equivocal results. We report three cases of motor and phonic tics successfully treated with BoNT-A. Methods: Case series with chart review. Results: A 28 year-old male presented with with refractory Tourette’s that progressed into loud screams and coprolalia causing depression and inpatient psychiatric care. He was treated with 1.25 units(u) BoNT-A to each thyroarytenoid titrated to 3.75u with a 27-gauge Teflon-coated monopolar EMG needle. He rated himself as “much better” and experienced a 50 percent reduction in tic loudness. Social impairments and tic intensity decreased from marked-severe to moderate on the Yale Global Tic Severity Scale (YGTSS.) A 26 year-old male presented with motor and phonic tics including grunting and coughing. He received 2.5u to the facial musculature and 2.5u to each supraglottic musculature via a transthyrohyoid membrane approach under fiberoptic visualization. He experienced reduction in the tic frequency, intensity, and interference with daily life on the YGTSS. A 14 year-old female with Tourette’s experienced phonic tics including loud screams. She received 1u to each thyroarytenoid titrated up to 2.5u with a decrease in tic loudness. Conclusions: We present three patients with validated subjective decreases in tic severity including the first report to our knowledge of successful treatment of phonic tics with a supraglottic injection. Results suggest a novel approach in treatment of phonic tics and bolster data regarding safe and effective use of BoNT for tics.