(BQ) Part 2 book "Manual of botulinum toxin thera" presentation of content: Treatment of stiff-person syndrome with botulinum neurotoxin, cosmetic uses of botulinum neurotoxins, hyperhidrosis, botulinum neurotoxin in wound healing, the use of botulinum neurotoxin in musculoskeletal pain and arthritis, botulinum neurotoxin in the gastrointestinal tract,. | Chapter 18 The use of botulinum neurotoxin in tic disorders and essential hand and head tremor Joseph Jankovic Manual of Botulinum Toxin Therapy, 2nd edition, ed. Daniel Truong, Mark Hallett, Christopher Zachary and Dirk Dressler. Published by Cambridge University Press. © Cambridge University Press 2013. Introduction This chapter describes aspects of tics and tremors including clinical features, oral medication treatment and the utility of botulinum neurotoxin (BoNT) injections as a therapeutic modality. Tics Tics are brief, sudden, movements (motor tics) or sounds (phonic tics) that are intermittent but may be repetitive and stereotypic (Jankovic and Kurlan, 2011). When motor tics and phonic tics coexist without other neurological abnormalities, the diagnosis of Tourette’s syndrome should be considered. Most patients with Tourette’s syndrome have also a variety of comorbid disorders such as attention deficit disorder, obsessive compulsive disorder and impulse control disorders. Tourette’s syndrome is considered a genetic neurodevelopmental disorder but its pathogenesis is not well understood (Jankovic and Kurlan, 2011). Although Tourette’s syndrome is the most common cause of childhoodonset tics, there are many other causes of tics, including autistic disorder and various insults to the brain and basal ganglia (infection, stroke, head trauma, drugs and neurodegenerative disorders). Clinical features of tics Motor and phonic tics consist of either simple or complex movements, which may be seemingly goal directed. Motor tics may be rapid (clonic) or more prolonged (tonic or dystonic). Many patients exhibit suggestibility and temporary suppressibility; they may also have a compulsive component, sometimes perceived as an irresistible need to perform the movement or sound repetitively until it feels “just right.” One feature that is particularly helpful in differentiating tics from other jerk-like movements is a premonitory sensation in the region of the tic or .
