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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.
