Objective: To provide a detailed overview of the wide spectrum of involuntary vocalizations in humans, their etiologies and treatment recommendations.

Background: Abnormal vocalizing behaviors are typically associated with tic disorders, notably Tourette syndrome. However, they may also be encountered throughout the entire tenor of neuropsychiatric disorders, to include movement disorders, dementing and neurodevelopmental syndromes, as well as functional neurological disorders and epilepsy. Although, in many of these disorders abnormal vocalizations will often be only one feature from a range of abnormal motor behaviors and clinical signs, in some cases they may constitute the sole clinical finding. Here, their early recognition and appropriate classification are paramount to guide diagnostic reasoning and inform therapeutic decisions. However, clinical literature on the topic, including video-documented cases is surprisingly scarce.

Method: Data from five expert centers of movement disorders were pooled. Cases of patients, where involuntary vocalizations predominated clinical presentation and where video material was available were collected. We also reviewed the literature in order to identify the range of possible etiologies associated with the different types of vocalizing behaviors and to explore treatment options.

Results: We classified involuntary vocalizations within the following categories: 1. Tics and tic-like vocalizations, including pali-, echo- and coprolalia, as well as klazomania. 2. Vocalizations related to stereotypies. 3. Vocalizations as part of chorea, dystonia or other dyskinesias 4. Continuous vocalizations such as groaning, moaning, grunting and shrieking. 5. Vocalizations resembling physiological reflexes. 6. Vocalizations as part of startle syndromes, ictal phenomena and sleep-related behaviors. Illustrative video-based examples are provided. A list of possible etiologies for the different vocalizations and a diagnostic algorithm are presented. Treatment options are discussed.

Conclusion: The range of involuntary vocalizations in humans is broad. Correct phenomenological classification is necessary to guide diagnosis and appropriate treatment selection.

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MDS Abstracts - https://www.mdsabstracts.org/abstract/the-spectrum-of-involuntary-vocalizations-in-humans/