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Question 61: I had the pleasure of hearing you speak in April 2002 at the York District Catholic School Board. At that time you made a reference to Botox, but did not elaborate any further. My son has a number of issues. He has hydrocephalus, cerebral palsy, ADHD, OCD, TS and a developmental disability. In January of this year he was given Botox injections in the hope it would allow leg muscles to do some needed growing. Since receiving the Botox injections, I have seen an increase in his TS. He has added some new vocalizations. Is there a correlation between these two things? K.B., ON, Canada.

Botox, or Botulinum Toxin Type A, is on occasion used as a treatment for TS -- when the tic is in a highly localized area. Typically Botox is used for very loud, inappropriate, or otherwise distressful vocal tics. The toxin is injected into the vocal cords, paralyzing them and rendering them incapable of performing the tic(s). Of course, given that this treatment globally compromises these muscles this means that volitional acts are also affected (i.e. speaking voice, swallowing, sneezing, burping, and coughing). Some may find that this "throws the baby out with the bathwater". Also, the treatment is fairly downstream in the sense that it only inhibits your ability to perform the tic -- not the neurology causing the tic, the urge to engage in the tic, or the tic attempts themselves. There is some evidence to suggest that the premonitory urge to tic decreases following Botox, but I can see how it might feel like you have an 'unscratchable itch" for those in whom it doesn't.

Having said all of that, to more directly respond to your question I have not heard of Botox ever causing increases in tics, either in the research or anecdotally. Given that the disinhibition inherent to TS can manifest in many different ways however, if the Botox injections to his legs eliminated any motor tics he used to have in that region it is possible that these new vocal tics are simply new 'release valves' that were created once the old avenue was blocked.

I hope this helps K.B.!
Dr. Dunc.

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