Botulinum toxin in the treatment of dystonic tics.

Botulinum toxin (BTX) injections provide effective treatment for a variety of disorders manifested by inappropriate muscle contractions, but its efficacy in the treatment of tics has not been previously studied. Ten male patients 13-53 years of age who were diagnosed with Tourette's syndrome manifested by disabling focal tics were included in this pilot study. Five patients had frequent blinking and blepharospasm, rendering them "blind," and five patients had severe and painful dystonic tics involving their neck muscles. All 10 patients experienced moderate to marked improvement in the intensity and frequency of tics after BTX injections into the involved muscles. Patients in whom premonitory urges preceded their tics noted marked lessening of these sensory symptoms. The benefit lasted 2-20 weeks after injections. There were no serious complications, except for transient ptosis in two and neck pain, stiffness, or weakness in three patients. BTX injections appear to be safe and effective treatment for patients with focal dystonic tics. The treatment ameliorates not only involuntary movements but also the premonitory sensory component associated with some tics.