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2 In all these instances, vocalizations are typically context specific and adaptive to environmental stimuli. 1 Our acquired repertoire of vocalizations ranges from simple sounds related to physiological reflexes (eg, sneezing) and emotional responses (eg, crying, laughing) to the intended articulation of words that are meant to express specific communicative content. The ability to vocalize has only been a fairly recent evolutionary acquisition and was a prerequisite for the development of verbal communication in our species. on behalf of International Parkinson and Movement Disorder Society.

Movement Disorders published by Wiley Periodicals, Inc. 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. We then expand on the pathophysiology of the different vocalizing behaviors and comment on available treatment options. We provide comprehensive lists of their associated etiologies, including neurodevelopmental, neurodegenerative, neuroimmunological, and structural causes and clinical clues. 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. 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. 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. Clinical literature and video-documented cases on the topic are surprisingly scarce. 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. However, they may also be encountered throughout the entire tenor of neuropsychiatry, movement disorders, and neurodevelopmental syndromes. In clinical practice, involuntary vocalizing behaviors are typically associated with Tourette syndrome and other tic disorders.