Levodopa-induced lateral jaw deviation dystonia

Use of botulinum toxin in the management of dystonia in Parkinson's disease

Botulinum toxin is one of the most potent neurotoxins, but when injected into an overactive muscle, it can transiently alleviate an involuntary movement, such as dystonia. The primary aim of this article is to provide a comprehensive review of the various forms of dystonia observed in patients with Parkinson's disease who can benefit from a therapeutic trial of botulinum toxin. Although most of these indications are not supported by randomized controlled clinical trials and, therefore, not approved by the Food and Drug Administration, there are many open-label trials supporting a large body of empirical experience testifying to the benefits of botulinum toxin treatment in these conditions.

Oromandibular dystonia seen during pramipexole treatment: A rare case

Dystonia is an abnormal, often repetitive, bending/twisting behavioral disorder characterized by continuous or intermittent muscle contraction. Oromandibular dystonia (OMD) is a type of dystonia involving chewing, mouth circumference, tongue, and platysma muscles. OMD is divided into different clinical types, including jaw opening OMD, jaw closing OMD, and mixed type OMD. OMD may either be primary or secondary to other diseases. The average patient age is between 50 and 60 years, and several studies have shown that it is more common among women. Dystonia may occur either as idiopathic (primary) or resulting from neurodegenerative diseases and other secondary dystonia. OMD can cause difficulty in speaking, chewing, and swallowing and produce pain during these movements. Therefore, OMD can lead to deterioration in an individual’s daily life and social relationships. Although dopaminergic drugs can be used in the treatment of dystonia, the aim of the study was to report that these drugs may also be a factor in further development of dystonia and to attract the attention of clinicians to this anomaly.

Levodopa-induced dyskinesia: clinical features, incidence, and risk factors

Symptoms of Parkinson's disease have been controlled with levodopa for many years; however, motor complications consisting of wearing off of medication effect and dyskinesias tend to occur within a few years of starting levodopa. Motor complications can begin a few months after taking levodopa, with the average time to onset estimated to be 6.5 years. Dyskinesias can be troublesome and require intervention. Levodopa-induced dyskinesia can be composed of a variety of movement disorders including chorea, dystonia, ballism, myoclonus, and akathisia. Based on the clinical pattern, the most common dyskinesia is chorea and choreoathetosis. The clinical manifestations can be divided into three main categories based on their clinical movement patterns and the temporal correlation between the occurrence of dyskinesia and the levodopa dosing: on or peak-dose dyskinesias, biphasic dyskinesias, and Off dyskinesias. Severe cases of dyskinesia have been reported, with the extreme being dyskinesia-hyperpyrexia syndrome. The prevalence of LID has been reported in many studies, but the reported incidence varies. The rate of LID development is from 3 to 94%. The prevalence of LID mainly depends on age at onset, disease duration, and severity, and duration of levodopa therapy. Some of the risk factors for the development of dyskinesia are modifiable. Modifiable risk factors include levodopa dose and body weight. Non-modifiable risk factors include age, gender, duration of disease, clinical subtype, disease progression, disease severity, and genetic factors.