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To determine the short-term and long-term treatment-effects of botulinum toxin type A in simple motor tics, we analyzed 15 consecutive patients (18 tics) with simple motor tics that were treated every 3 months with injections of BTX-A. Efficacy (rated on a 4-level scale) and duration of effect of the first 2 and last 2 (if treated 5 times or more) treatments were recorded, as well as latency of response, changes of premonitory urges (PMUs) and possible side effects. Total number of treatments for each tic varied from 2 to 50 (mean 11, median 6). In 16 of 18 tics (89%) short-term efficacy was reported successful (good or moderate). Long-term efficacy was reported in 12 tics of which 11 showed similar or even increased beneficial effects. Premonitory urge (PMU) was reported in 8 patients (53%). PMU, if present, lessened or disappeared after treatment with BTX-A. A permanent remission of the treated tic was seen in 3 patients with a maximum follow-up of 10 years. BTX-A appears a safe and effective treatment for simple motor tics and retains its efficacy after long-term treatment. BTX may also induce permanent remission of the treated tics and effects of BTX are not restricted to merely motor behaviour.

In 20 Tourette patients and 20 control subjects auditory event-related potentials evoked in an oddball paradigm were studied in 2 conditions: a non-motor condition (NMC) in which subjects had to attend tones, and a motor condition (MC) in which they had to press a microswitch to deviant tones. In the NMC patients had a reduced P2 in response to the standards. The deviant-standard subtraction wave forms of the NMC showed a discernible MMN-P165-N2b-P3 complex in the controls, whereas in the patients only the P3 was well developed. In the MC patients had a reduced N1 to the standards. Both groups showed in the deviant-standard subtraction wave forms a clear MMN-P165-N2b-P3 complex, N2b being reduced in the patients. In the patients the P2 amplitude and latency to the standards and in the controls the N2b amplitude in the deviant-standard subtraction wave form were larger in the MC than in the NMC. Both groups also showed a larger P3 and a larger parietal slow positive wave in the MC than in the NMC. The results are discussed in relation to behavioural and neuropsychological disturbances found in Gilles de la Tourette's syndrome.

• A persistent blink reflex to light (BRL) was observed in a patient who became comatose after a cardiac arrest. Postmortem examination revealed severe hypoxic ganglion cell necrosis of the cerebral and cerebellar cortex, the basal ganglia, the hypothalamus, nuclei in the brain stem, and the superior colliculi. The pretectum was unaffected. These findings suggest that the afferent fibers of the BRL enter the brain stem not in the superior colliculus, but in the pretectum.