The spectrum of involuntary vocalizations in humans: A video atlas

Abstract

In clinical practice, involuntary vocalizing behaviors are typically associated with Tourette syndrome and other tic disorders. However, they may also be encountered throughout the entire tenor of neuropsychiatry, movement disorders, and neurodevelopmental syndromes. Importantly, involuntary vocalizing behaviors may often constitute a predominant clinical sign, and, therefore, their early recognition and appropriate classification are necessary to guide diagnosis and treatment. Clinical literature and video‐documented cases on the topic are surprisingly scarce. Here, we pooled data from 5 expert centers of movement disorders, with instructive video material to cover the entire range of involuntary vocalizations in humans. Medical literature was also reviewed to document the range of possible etiologies associated with the different types of vocalizing behaviors and to explore treatment options. We propose a phenomenological classification of involuntary vocalizations within different categorical domains, including (1) tics and tic‐like vocalizations, (2) vocalizations as part of stereotypies, (3) vocalizations as part of dystonia or chorea, (4) continuous vocalizing behaviors such as groaning or grunting, (5) pathological laughter and crying, (6) vocalizations resembling physiological reflexes, and (7) other vocalizations, for example, those associated with exaggerated startle responses, as part of epilepsy and sleep‐related phenomena. We provide comprehensive lists of their associated etiologies, including neurodevelopmental, neurodegenerative, neuroimmunological, and structural causes and clinical clues. We then expand on the pathophysiology of the different vocalizing behaviors and comment on available treatment options. Finally, we present an algorithmic approach that covers the wide range of involuntary vocalizations in humans, with the ultimate goal of improving diagnostic accuracy and guiding appropriate treatment. © 2019 The Authors. Movement Disorders published by Wiley Periodicals, Inc. on behalf of International Parkinson and Movement Disorder Society.

Throat‐Clearing Vocalizations in Primary Brain Calcification Syndromes

“…4,7 Involuntary vocalizations have not hitherto been highlighted as a major feature of brain calcification syndromes. Palilalia and echolalia are occasionally reported, 4,8,9 while guttural vocalizations have only been described once previously. 10 Altered limbic-PAG connectivity associated with pathological intracranial calcification may be the driver of abnormal utterances in these cases, and one may surmise that the similar throat-clearing qualities in all cases(Table 1) reflects distinct patterns of limbic involvement, leading to preferential activation of PAG neurons controlling guttural sounds.…”

The Spectrum of Repetitive Behaviors Associated With Subacute Sclerosing Panencephalitis

“… 14–22 Also, in clinical practice, involuntary vocalizations may be encountered in a variety of other neurological conditions. Mainka and colleagues recently proposed a phenomenological classification of involuntary vocalizations within different categorical domains, including tics and tic‐like vocalizations, vocalizations as part of stereotypies, dystonia and chorea, continuous vocalization behavior (groaning and grunting), pathological laughter and crying, vocalizations resembling physiological reflexes, and other vocalizations (exaggerated startled responses, epilepsy, and sleep related) 23 . In our SSPE patients, involuntary vocalizations were palilalia, whistling, grunting with spitting, and pathological crying.…”

Tourette syndrome research highlights from 2019

“…Martino and Hedderly provide an excellent review on the differences between tics and stereotypies, and their clinical management 2 A useful resource is the video atlas of various vocalizations that includes tics and helps with differential diagnosis 3 .…”