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Mathis S, Solé G, Damon-Perrière N, Rouanet-Larrivière M, Duval F, Prigent J, Nadal L, Péréon Y, Le Masson G. Clinical Neurology in Practice: The Tongue (part 2). Neurologist 2024; 29:59-69. [PMID: 37639532 DOI: 10.1097/nrl.0000000000000510] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 08/31/2023]
Abstract
BACKGROUND The tongue is an essential organ for the development of certain crucial functions such as swallowing and speech. The examination of the tongue can be very useful in neurology, as the various types of lingual alterations can lead to certain specific diagnoses, the tongue being a kind of 'mirror' of some neurological function. REVIEW SUMMARY To discuss the elements of clinical examination of the tongue in relation to neurological disorders. After reviewing the different superficial lesions of the tongue, we deal with various movement disorders of the tongue (fasciculations/myokimia, orolingual tremor, choreic movements of the tongue, dystonia of the tongue, lingual myoclonus, and psychogenic movements), disorders of taste and lingual sensitivity and lingual pain. CONCLUSIONS Examination of the tongue should not be limited to studying its motility and trophicity. It is equally important to check the sensory function and understand how to interpret abnormal movements involving the tongue. This study also aimed to demonstrate the importance of nonmotor tongue function in neurological practice.
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Affiliation(s)
- Stéphane Mathis
- Department of Neurology, Muscle-Nerve Unit, University Hospitals of Bordeaux (CHU Bordeaux - Pellegrin Hospital), University of Bordeaux, Bordeaux, France
- Referral Center for Neuromuscular Diseases 'AOC', University Hospitals of Bordeaux (CHU Bordeaux - Pellegrin Hospital), University of Bordeaux, Bordeaux, France
- ALS Center, University Hospitals of Bordeaux (CHU Bordeaux - Pellegrin Hospital), University of Bordeaux, Bordeaux, France
| | - Guilhem Solé
- Department of Neurology, Muscle-Nerve Unit, University Hospitals of Bordeaux (CHU Bordeaux - Pellegrin Hospital), University of Bordeaux, Bordeaux, France
- Referral Center for Neuromuscular Diseases 'AOC', University Hospitals of Bordeaux (CHU Bordeaux - Pellegrin Hospital), University of Bordeaux, Bordeaux, France
| | - Nathalie Damon-Perrière
- Department of Clinical Neurophysiology, University Hospitals of Bordeaux (CHU Bordeaux - Pellegrin Hospital), University of Bordeaux, Bordeaux, France
- Department of Movement disorders, University Hospitals of Bordeaux (CHU Bordeaux - Pellegrin Hospital), University of Bordeaux, Bordeaux, France
| | - Marie Rouanet-Larrivière
- Department of Clinical Neurophysiology, University Hospitals of Bordeaux (CHU Bordeaux - Pellegrin Hospital), University of Bordeaux, Bordeaux, France
| | - Fanny Duval
- Department of Neurology, Muscle-Nerve Unit, University Hospitals of Bordeaux (CHU Bordeaux - Pellegrin Hospital), University of Bordeaux, Bordeaux, France
- Referral Center for Neuromuscular Diseases 'AOC', University Hospitals of Bordeaux (CHU Bordeaux - Pellegrin Hospital), University of Bordeaux, Bordeaux, France
| | - Julia Prigent
- Department of Neurology, Muscle-Nerve Unit, University Hospitals of Bordeaux (CHU Bordeaux - Pellegrin Hospital), University of Bordeaux, Bordeaux, France
| | - Louis Nadal
- Department of Neurology, Muscle-Nerve Unit, University Hospitals of Bordeaux (CHU Bordeaux - Pellegrin Hospital), University of Bordeaux, Bordeaux, France
| | - Yann Péréon
- CHU Nantes, Reference Centre for Neuromuscular Diseases AOC, Filnemus, Nantes, France
| | - Gwendal Le Masson
- Department of Neurology, Muscle-Nerve Unit, University Hospitals of Bordeaux (CHU Bordeaux - Pellegrin Hospital), University of Bordeaux, Bordeaux, France
- Referral Center for Neuromuscular Diseases 'AOC', University Hospitals of Bordeaux (CHU Bordeaux - Pellegrin Hospital), University of Bordeaux, Bordeaux, France
- ALS Center, University Hospitals of Bordeaux (CHU Bordeaux - Pellegrin Hospital), University of Bordeaux, Bordeaux, France
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2
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Salari M, Rezaei K, Mirdehghan A, Behzadi A, Etemadifar M. A review on approach to a twitchy tongue in neurology. Neurol Sci 2023:10.1007/s10072-023-06771-3. [PMID: 37043038 DOI: 10.1007/s10072-023-06771-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/29/2022] [Accepted: 03/20/2023] [Indexed: 04/13/2023]
Abstract
BACKGROUND Several etiologies are responsible for presentation of a twitching tongue in clinical practice. Some of these etiologies cause an isolated hyperkinetic tongue muscle, and some others cause it along with other signs and symptoms. OBJECTIVES The present paper aims to review the causes, pathology, and presentations reported with twitchy tongue. An anatomical basis of the etiologies responsible for presentation of a twitchy tongue and hyperkinetic movement disorders of this muscle is pursued. METHOD The reporting of this systematic review was guided by the standards of the Preferred Reporting Items for Systematic Review and Meta-Analysis (PRISMA) Statement. All of the research papers conducted with keywords described in the method section between 2000 and 2022 were used, and review articles and articles without any human subject and without any described hyperkinetic movement disorders of the tongue were excluded. RESULTS All of the etiologies responsible for hyperkinetic movement disorders of tongue were listed in the basis of their anatomical site of effect; cortical region, basal ganglia, cerebellum, brain stem, nucleus and nerve, and neuromuscular junction. One last remained part is the "not classified" section, which contains the etiologies with no particular anatomical origin. CONCLUSION There are a variety of responsible etiologies for presentation of a twitchy tongue, and in the matter of a complaint of hyperkinetic tongue presentation, physicians should consider anatomical, functional, and psychological etiologies and other signs and symptoms must be participated in the diagnosis process to achieve a proper medical decision.
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Affiliation(s)
- Mehri Salari
- Functional Neurosurgery Research Center, Shohada Tajrish Comprehensive Neurosurgical Center of Excellence, Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | - Kamran Rezaei
- Student Research Committee, School of Medicine, Shahid Beheshti University of Medical Science, Tehran, Iran.
| | - Alimohammad Mirdehghan
- Student Research Committee, School of Medicine, Shahid Beheshti University of Medical Science, Tehran, Iran
| | - Arya Behzadi
- Student Research Committee, School of Medicine, Shahid Beheshti University of Medical Science, Tehran, Iran
| | - Masoud Etemadifar
- Department of Functional Neurosurgery, Medical School, Isfahan University of Medical Science, Isfahan, Iran
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Stephen CD, Dy-Hollins M, Gusmao CMD, Qahtani XA, Sharma N. Dystonias: Clinical Recognition and the Role of Additional Diagnostic Testing. Semin Neurol 2023; 43:17-34. [PMID: 36972613 DOI: 10.1055/s-0043-1764292] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/29/2023]
Abstract
Dystonia is the third most common movement disorder, characterized by abnormal, frequently twisting postures related to co-contraction of agonist and antagonist muscles. Diagnosis is challenging. We provide a comprehensive appraisal of the epidemiology and an approach to the phenomenology and classification of dystonia, based on the clinical characteristics and underlying etiology of dystonia syndromes. We discuss the features of common idiopathic and genetic forms of dystonia, diagnostic challenges, and dystonia mimics. Appropriate workup is based on the age of symptom onset, rate of progression, whether dystonia is isolated or combined with another movement disorder or complex neurological and other organ system eatures. Based on these features, we discuss when imaging and genetic should be considered. We discuss the multidisciplinary treatment of dystonia, including rehabilitation and treatment principles according to the etiology, including when pathogenesis-direct treatment is available, oral pharmacological therapy, chemodenervation with botulinum toxin injections, deep brain stimulation and other surgical therapies, and future directions.
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Affiliation(s)
| | - Marisela Dy-Hollins
- Department of Neurology, Massachusetts General Hospital, Boston, Massachusetts
| | | | - Xena Al Qahtani
- Department of Neurology, Massachusetts General Hospital, Boston, Massachusetts
| | - Nutan Sharma
- Department of Neurology, Massachusetts General Hospital, Boston, Massachusetts
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4
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Szalisznyó K, Silverstein DN. Why Does Tardive Dyskinesia Have Oro-facial Predominance? A Network Analysis. Brain Topogr 2023; 36:99-105. [PMID: 36592263 PMCID: PMC9834360 DOI: 10.1007/s10548-022-00931-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/02/2022] [Accepted: 11/27/2022] [Indexed: 01/03/2023]
Abstract
Tardive dyskinesia is a involuntary hyperkinetic disorder which usually occurs in older patients after long-term treatment with antipsychotic drugs. These dyskinesias are mostly irreversible and are frequently expressed in the tongue, cheeks, mandible, perioral area and other regions of the face. In this theoretical study we asked the question, why does tardive dyskinesia often have orofacial predominance? What might be the underlying neural network structure which contributes to this propensity? Graph analysis of high-level cortico-striato-thalamo-cortical network structure suggests a connectivity bottleneck. The number of walks of different lengths from the substantia nigra pars reticulata (SNr) to other vertices, as well as the returning cycles are the lowest in the network, which may indicate a higher damage susceptibility of this node. Analysis was also performed on published data from a recent high resolution histological study on cortico-striato-thalamo-cortical networks in rodents. Finer network partitioning and adjacency matrices demonstrated that the SNr has a heterogeneous connectivity structure and the number of local walks from nodes neighboring orofacial neural representation is higher, indicating possible early compensatory escape routes. However, with more extensive SNr damage the larger circuit compensation might be limited. This area of inquiry is important for future research, because identifying key vulnerable structures may provide more targeted therapeutical interventions.
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Affiliation(s)
- Krisztina Szalisznyó
- Department of Medical Sciences, Psychiatry, Uppsala University, Uppsala University Hospital, 75185 Uppsala, Sweden
- Computational Sciences Department, Theoretical Neuroscience and Complex Systems Research Group, Wigner Research Centre for Physics, Budapest, 1121 Hungary
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5
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Ghadery CM, Kalia LV, Connolly BS. Movement disorders of the mouth: a review of the common phenomenologies. J Neurol 2022; 269:5812-5830. [PMID: 35904592 DOI: 10.1007/s00415-022-11299-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/20/2022] [Revised: 07/16/2022] [Accepted: 07/18/2022] [Indexed: 11/26/2022]
Abstract
Movement disorders of the mouth encompass a spectrum of hyperactive movements involving the muscles of the orofacial complex. They are rare conditions and are described in the literature primarily in case reports originating from neurologists, psychiatrists, and the dental community. The focus of this review is to provide a phenomenological description of different oral motor disorders including oromandibular dystonia, orofacial dyskinesia and orolingual tremor, and to offer management strategies for optimal treatment based on the current literature. A literature search of full text studies using PubMed/Medline and Cochrane library combined with a manual search of the reference lists was conducted until June 2021. Results from this search included meta-analyses, systematic reviews, reviews, clinical studies, case series, and case reports published by neurologists, psychiatrists, dentists and oral and maxillofacial surgeons. Data garnered from these sources were used to provide an overview of most commonly encountered movement disorders of the mouth, aiding physicians in recognizing these rare conditions and in initiating appropriate therapy.
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Affiliation(s)
- C M Ghadery
- Division of Neurology, Department of Medicine, McMaster University, 237 Barton Street East, Hamilton, ON, L8L 2X2, Canada
| | - L V Kalia
- Division of Neurology, Department of Medicine, Morton and Gloria Shulman Movement Disorders Clinic and the Edmond J Safra Program in Parkinson's Disease, Toronto Western Hospital, University Health Network, University of Toronto, Toronto, ON, Canada
| | - B S Connolly
- Division of Neurology, Department of Medicine, McMaster University, 237 Barton Street East, Hamilton, ON, L8L 2X2, Canada.
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6
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Krishnan S, Saraf U, Chandarana M, Divya KP. Oromandibular dystonia – A systematic review. Ann Indian Acad Neurol 2022; 25:26-34. [PMID: 35342238 PMCID: PMC8954320 DOI: 10.4103/aian.aian_242_21] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/22/2021] [Revised: 08/10/2021] [Accepted: 09/04/2021] [Indexed: 11/04/2022] Open
Abstract
Oromandibular dystonia (OMD) is a clinical problem which is commonly encountered in the practice of movement disorders. OMD results from a variety of genetic and acquired etiologies and can occur as an isolated manifestation, or as part of an isolated generalized or a combined dystonia syndrome. There are only very few systematic reviews on this condition which often causes significant disability. We review here the etiology, clinical features, diagnostic approach and management of OMD.
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7
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Bhidayasiri R, Maytharakcheep S, Truong DD. Patient selection and injection techniques for botulinum neurotoxin in oromandibular dystonia. Clin Park Relat Disord 2022; 7:100160. [PMID: 36033904 PMCID: PMC9399243 DOI: 10.1016/j.prdoa.2022.100160] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/01/2022] [Revised: 07/20/2022] [Accepted: 08/02/2022] [Indexed: 11/06/2022] Open
Abstract
Botulinum toxin is considered as the first-line therapy in oromandibular dystonia (OMD) by most experts and evidence-based literature. Oromandibular dystonia (OMD) can be classified into several subtypes so primary muscle involvements can be identified for botulinum toxin (BoNT) injections. This review article aims to provide a framework for practical clinical approaches in patients with OMD for BoNT injections. Careful stepwise planning is recommended to identify primary muscles responsible and employ a conservative approach to dosing titration. Treating physicians should be diligent to observe for adverse events as muscles involved in OMD are small, delicate and situated in close proximity.
Oromandibular dystonia (OMD) is a form of focal dystonia that involves the masticatory, lower facial, labial, and lingual musculature. It is a disabling disorder which had limited treatment options until the recent introduction of botulinum toxin (BoNT) as the recommended first-line therapy by most experts and evidence-based literature. Owing to the complex relationship between the muscles of mastication and surrounding muscles, there is a wide variety of dynamic clinical presentations, making clinical recognition and the corresponding approach to BoNT injection therapy difficult. In this review, the authors provide a framework for practical clinical approaches, beginning with the recognition of clinical subtypes of OMD (jaw-opening, jaw-closing, jaw-deviating, lingual, peri-oral, and/or pharyngeal dystonias), followed by patient selection and clinical evaluation to determine function interferences, with injection techniques illustrated for each subtype. Careful stepwise planning is recommended to identify the muscles that are primarily responsible and employ a conservative approach to dosing titration. Treating physicians should be diligent in checking for adverse events, especially for the first few injection cycles, as muscles involved in OMD are small, delicate, and situated in close proximity. It is recommended that future studies should aim to establish the clinical efficacy of each subtype, incorporating muscle targeting techniques and patient-centred outcome measures that are related to disturbed daily functions.
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8
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Scorr LM, Factor SA, Parra SP, Kaye R, Paniello RC, Norris SA, Perlmutter JS, Bäumer T, Usnich T, Berman BD, Mailly M, Roze E, Vidailhet M, Jankovic J, LeDoux MS, Barbano R, Chang FCF, Fung VSC, Pirio Richardson S, Blitzer A, Jinnah HA. Oromandibular Dystonia: A Clinical Examination of 2,020 Cases. Front Neurol 2021; 12:700714. [PMID: 34603182 PMCID: PMC8481678 DOI: 10.3389/fneur.2021.700714] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/26/2021] [Accepted: 08/12/2021] [Indexed: 12/31/2022] Open
Abstract
Objective: The goal of this study is to better characterize the phenotypic heterogeneity of oromandibular dystonia (OMD) for the purpose of facilitating early diagnosis. Methods: First, we provide a comprehensive summary of the literature encompassing 1,121 cases. Next, we describe the clinical features of 727 OMD subjects enrolled by the Dystonia Coalition (DC), an international multicenter cohort. Finally, we summarize clinical features and treatment outcomes from cross-sectional analysis of 172 OMD subjects from two expert centers. Results: In all cohorts, typical age at onset was in the 50s and 70% of cases were female. The Dystonia Coalition cohort revealed perioral musculature was involved most commonly (85%), followed by jaw (61%) and tongue (17%). OMD more commonly appeared as part of a segmental dystonia (43%), and less commonly focal (39%) or generalized (10%). OMD was found to be associated with impaired quality of life, independent of disease severity. On average, social anxiety (LSA score: 33 ± 28) was more common than depression (BDI II score: 9.7 ± 7.8). In the expert center cohorts, botulinum toxin injections improved symptom severity by more than 50% in ~80% of subjects, regardless of etiology. Conclusions: This comprehensive description of OMD cases has revealed novel insights into the most common OMD phenotypes, pattern of dystonia distribution, associated psychiatric disturbances, and effect on QoL. We hope these findings will improve clinical recognition to aid in timely diagnosis and inform treatment strategies.
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Affiliation(s)
- Laura M. Scorr
- Department of Neurology, Emory University, Atlanta, GA, United States
| | - Stewart A. Factor
- Department of Neurology, Emory University, Atlanta, GA, United States
| | | | - Rachel Kaye
- Department of Otolaryngology, Rutgers University, Newark, NJ, United States
| | - Randal C. Paniello
- Department of Neurology, Washington University School of Medicine, St. Louis, MO, United States
| | - Scott A. Norris
- Department of Neurology, Washington University School of Medicine, St. Louis, MO, United States
| | - Joel S. Perlmutter
- Department of Neurology, Washington University School of Medicine, St. Louis, MO, United States
| | - Tobias Bäumer
- Department of Neurology, Institute of Systems Motor Science, Universität of Lübeck, Lübeck, Germany
| | - Tatiana Usnich
- Department of Neurology, Institute of Systems Motor Science, Universität of Lübeck, Lübeck, Germany
| | - Brian D. Berman
- Department of Neurology, University of Colorado Anschutz Medical Campus, Aurora, CO, United States
| | - Marie Mailly
- Department of ENT and Head and Neck Surgery, Fondation Adolphe de Rothschild, Paris, France
| | - Emmanuel Roze
- Department of Neurology, Hôpital de la Pitié Salpétrière, Assistance Publique-Hôpitaux de Paris, Paris, France
| | - Marie Vidailhet
- Department of Neurology, Hôpital de la Pitié Salpétrière, Assistance Publique-Hôpitaux de Paris, Paris, France
| | - Joseph Jankovic
- Baylor St. Luke's Medical Center, Houston, TX, United States
| | - Mark S. LeDoux
- Veracity Neuroscience LLC, Memphis, TN, United States
- Department of Neurology, University of Memphis, Memphis, TN, United States
| | - Richard Barbano
- Department of Neurology, University of Rochester, Rochester, NY, United States
| | - Florence C. F. Chang
- Department of Neurology, Westmead Hospital and Sydney Medical School, University of Sydney, Sydney, NSW, Australia
| | - Victor S. C. Fung
- Department of Neurology, Westmead Hospital and Sydney Medical School, University of Sydney, Sydney, NSW, Australia
| | - Sarah Pirio Richardson
- Department of Neurology, University of New Mexico Health Sciences Center, Albuquerque, NM, United States
| | - Andrew Blitzer
- Head and Neck Surgical Group, New York, NY, United States
| | - H. A. Jinnah
- Department of Neurology, Emory University, Atlanta, GA, United States
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9
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Gümüş YY, Say GN. Oromandibular Dystonia Treatment With Aripiprazole in an Adolescent Patient 2-Year Follow-Up: A Case Report. PSYCHIAT CLIN PSYCH 2021; 31:358-360. [PMID: 38765940 PMCID: PMC11079663 DOI: 10.5152/pcp.2021.21068] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/05/2021] [Accepted: 08/06/2021] [Indexed: 05/22/2024] Open
Abstract
Oromandibular dystonia (OMD) is a movement disorder that can cause considerable functional and psychosocial disability such as dysphagia, dysarthria, breathing difficulty, weight loss, social withdrawal, and depression. Oromandibular dystonia has no known cure. Many different treatment approaches can be used for the treatment of OMD. In this case report, we present a 16-year-old female adolescent patient with OMD, who showed a significant improvement with the use of 5 mg/day aripiprazole during the 2-year follow-up.
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Affiliation(s)
- Yusuf Yasin Gümüş
- Department of Child and Adolescent Psychiatry, Ondokuz Mayis University School of Medicine, Samsun, Turkey
| | - Gökçe Nur Say
- Department of Child and Adolescent Psychiatry, Ondokuz Mayis University School of Medicine, Samsun, Turkey
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Ray S, Kutty B, Pal PK, Yadav R. Sleep and other Non-motor Symptoms in Patients with Idiopathic Oromandibular Dystonia and Meige Syndrome: A Questionnaire-based Study. Ann Indian Acad Neurol 2021; 24:351-355. [PMID: 34446996 PMCID: PMC8370173 DOI: 10.4103/aian.aian_906_20] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/19/2020] [Revised: 08/27/2020] [Accepted: 09/17/2020] [Indexed: 11/27/2022] Open
Abstract
Introduction: Non-motor symptoms are an essential cause of comorbidity in generalized and focal dystonia. However, there are few studies on dystonia involving the craniofacial regions. Methods: We studied non-motor symptoms in patients with oromandibular dystonia (OMD) and Meige syndrome using a questionnaire, and validated instruments for depression, anxiety, REM behaviour disorder, restless leg syndrome, sleep quality, excessive daytime sleepiness, and self-esteem. The severity of dystonia and blepharospasm was also studied. Results: Nineteen patients with OMD were recruited into the study. Among patients with OMD, depression was seen in 63.6% (n = 7), sleep impairment in 27.3% (n = 3), excessive daytime sleepiness in 27.3% (n = 3), and poor self- esteem in 18.2% (n = 2) of the patients. Among patients with Meige syndrome, depression was seen in 37.5% (n = 3), sleep impairment in 12.5% (n = 1), excessive daytime sleepiness in 25% (n = 2), low self-esteem in 25% (n = 2) of the patients. Conclusion: This study highlights the significant frequency of depression and sleep disturbances in patients with idiopathic OMD and Meige syndrome.
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Affiliation(s)
- Somdattaa Ray
- Department of Neurology, National Institute of Mental Health and Neurosciences (NIMHANS), Bengaluru, Karnataka, India
| | - Bindu Kutty
- Department of Neurophysiology, National Institute of Mental Health and Neurosciences (NIMHANS), Bengaluru, Karnataka, India
| | - Pramod Kumar Pal
- Department of Neurology, National Institute of Mental Health and Neurosciences (NIMHANS), Bengaluru, Karnataka, India
| | - Ravi Yadav
- Department of Neurology, National Institute of Mental Health and Neurosciences (NIMHANS), Bengaluru, Karnataka, India
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11
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Yoshida K. [Therapeutic strategies for oromandibular dystonia]. FORTSCHRITTE DER NEUROLOGIE-PSYCHIATRIE 2021; 89:562-572. [PMID: 33638139 DOI: 10.1055/a-1375-0669] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 10/22/2022]
Abstract
Oromandibular dystonia is characterized by tonic or clonic involuntary spasms of the masticatory, lingual and / or muscles in the stomatognathic system. It is often misdiagnosed as craniomandibular dysfunction or psychiatric disease. According to clinical features, the oromandibular dystonia is classified into 6 subtypes (jaw closing-, jaw opening-, tongue-, jaw deviation-, jaw protrusion-, and lip dystonia). There are several treatment methods like botulinum toxin injection, muscle afferent block (injection of lidocaine and alcohol into the masticatory or tongue muscles for blocking muscle afferents from muscle spindle), occlusal splint, and oral surgery (coronoidotomy). Most of patients can be treated successfully according to subtype by combination of these treatments. Special treatment recommendations for each subtype were described in this focus article. Accurate diagnosis and treatment of oral dystonia requires comprehensive knowledge and skills of both oral and maxillofacial surgery and neurology. Therefore, collaboration among these departments is very important.
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Affiliation(s)
- Kazuya Yoshida
- Department of Oral and Maxillofacial Surgery, National Hospital Organization, Kyoto Medical Center
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12
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Abstract
Tardive syndrome (TS) is an iatrogenic, often persistent movement disorder caused by drugs that block dopamine receptors. It has a broad phenotype including movement (orobuccolingual stereotypy, dystonia, tics, and others) and nonmotor features (akathisia and pain). TS has garnered increased attention of late because of the Food and Drug Administration approval of the first therapeutic agents developed specifically for this purpose. This paper will begin with a discussion on pathogenesis, clinical features, and epidemiology. However, the main focus will be treatment options currently available for TS including a suggested algorithm based on current evidence. Recently, there have been significant advances in TS therapy, particularly with the development of 2 new vesicular monoamine transporter type 2 inhibitors for TS and with new data on the efficacy of deep brain stimulation. The discussion will start with switching antipsychotics and the use of clozapine monotherapy which, despite the lack of higher-level evidence, should be considered for the treatment of psychosis and TS. Anti-dyskinetic drugs are separated into 3 tiers: 1) vesicular monoamine transporter type 2 inhibitors, which have level A evidence, are approved for use in TS and are recommended first-choice agents; 2) drugs with lower level of evidence for efficacy including clonazepam, Ginkgo biloba, and amantadine; and 3) drugs that have the potential to be beneficial, but currently have insufficient evidence including levetiracetam, piracetam, vitamin B6, melatonin, baclofen, propranolol, zolpidem, and zonisamide. Finally, the roles of botulinum toxin and surgical therapy will be examined. Current therapies, though improved, are symptomatic. Next steps should focus on the prevention and reversal of the pathogenic process.
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Affiliation(s)
- Stewart A Factor
- Jean and Paul Amos Parkinson's Disease and Movement Disorder Program, Emory University School of Medicine, 12 Executive Park Drive Northeast, Atlanta, Georgia, 30329, USA.
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13
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De Meyer M, Vereecke L, Bottenberg P, Jacquet W, Sims AB, Santens P. Oral appliances in the treatment of oromandibular dystonia: a systematic review. Acta Neurol Belg 2020; 120:831-836. [PMID: 32594465 DOI: 10.1007/s13760-020-01404-4] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/20/2020] [Accepted: 06/08/2020] [Indexed: 12/29/2022]
Abstract
Oromandibular dystonia (OMD) is a clinically and etiologically heterogeneous form of focal dystonia with variable social and functional implications. The results of pharmacological treatment and botulinum toxin infiltrations are often unsatisfactory. We performed a systematic review on the effects of oral and dental appliances in patients with OMD. Most of the reports in the literature are single subject descriptions or small case series with a considerable variability in the type of dystonia, the type of evaluated appliances and in the outcome measures. Only one report included a large group of unselected patients that were evaluated with a mixture of outcome measures. Although it appears that a number of OMD patients, especially those who benefit from sensory tricks, may sustain some improvement with the use of oral appliances, no definitive conclusions can be drawn about the type of patients that may benefit, nor about the preferred type or mode of appliance. More research in this field is needed, using standardized approaches and clearly defined outcome measures in larger cohorts of OMD patients that are clinically and diagnostically well characterized.
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Affiliation(s)
- Micheline De Meyer
- Department of Oral Health Sciences, Ghent University, Ghent, Belgium
- Department of Dentistry, Radboud University Medical Center and Radboud Institute for Health Sciences, Nijmegen, The Netherlands
| | - Lisa Vereecke
- Department of Oral Health Sciences, Ghent University, Ghent, Belgium
| | - Peter Bottenberg
- Oral Health Research Group, Faculty of Medicine and Pharmacy, Vrije Universiteit Brussel, Brussels, Belgium
| | - Wolfgang Jacquet
- Oral Health Research Group, Faculty of Medicine and Pharmacy, Vrije Universiteit Brussel, Brussels, Belgium
- Department of Educational Sciences, Faculty of Psychology and Educational Sciences, Vrije Universiteit Brussel, Brussels, Belgium
- Department of Periodontology and Oral Implantology, Faculty of Medicine and Health Sciences, Ghent University, Ghent, Belgium
- Department of Materials, Textiles and Chemical Engineering, Ghent University, Ghent, Belgium
| | - Anthony B Sims
- The Maryland Center for Craniofacial, TMJ and Dental Sleep Disorders, Columbia, MD, USA
| | - Patrick Santens
- Department of Neurology, Ghent University Hospital, Corneel Heymanslaan 10, 9000, Ghent, Belgium.
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Holla VV, Yadav R, Iyer V, Chaithra S, Stezin A, Pal PK. Reversible orolingual dyskinesia in a case of juvenile onset psychosis and cognitive decline. Parkinsonism Relat Disord 2020; 76:72-74. [DOI: 10.1016/j.parkreldis.2019.12.014] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/17/2018] [Revised: 07/17/2019] [Accepted: 12/25/2019] [Indexed: 10/25/2022]
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Sude A, Nixdorf DR. Prevalence and clinical characteristics of patients with oromandibular dystonia seen in the orofacial pain clinic: a retrospective study. Oral Surg Oral Med Oral Pathol Oral Radiol 2020; 130:169-174. [PMID: 32540317 DOI: 10.1016/j.oooo.2020.05.002] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/15/2020] [Revised: 04/06/2020] [Accepted: 05/04/2020] [Indexed: 10/24/2022]
Abstract
OBJECTIVE The aim of this study was to describe the prevalence and clinical characteristics of patients with oromandibular dystonia (OMD) presenting to an academic orofacial pain clinic. OMD diagnosis was based on clinical signs and symptoms, presenting in varied forms and severities. Knowledge of clinical characteristics would help in early diagnosis and treatment of OMD. STUDY DESIGN In this retrospective study, we identified patients with OMD (International Classification of Diseases [ICD]-9 diagnostic code 333.82 and ICD-10 code G24.4) who presented at the clinic from October 2012 to December 2017. Additional selection criteria were age greater than 18 years and confirmation of OMD diagnosis with at least 1 follow-up visit. RESULTS Over a 5-year period, 22 patients with OMD were identified according to the ICD diagnostic codes, and of those, 6 patients met the selection criteria corresponding to a prevalence of 170 per 100,000 (95% confidence interval [CI] 70-390). The most common chief complaint was jaw pain (67%), and all patients had associated diagnosis of myofascial pain of masticatory muscles. CONCLUSIONS The prevalence of patients with OMD in an academic orofacial pain clinic is higher than previously reported in population-based studies. The presentation of OMD often includes temporomandibular disorders (TMDs), with involvement of various masticatory muscles.
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Affiliation(s)
- Asha Sude
- Division of TMD & Orofacial Pain, Department of Diagnostic and Biological Sciences, School of Dentistry, University of Minnesota, Minneapolis, MN, USA; Department of Neurosurgery, Medical School, University of Minnesota, Minneapolis, MN, USA
| | - Donald R Nixdorf
- Division of TMD & Orofacial Pain, Department of Diagnostic and Biological Sciences, School of Dentistry, University of Minnesota, Minneapolis, MN, USA; Department of Neurology, Medical School, University of Minnesota, Minneapolis, MN, USA; Health Partners Institute for Education and Research, Bloomington, MN, USA.
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Shalash AS, Abushouk AI, Elsherbeny MY, Elrassas H, Kamel T. Refractory Open Jaw Oromandibular Tardive Dystonia with a Sensory Trick, Treated with Botulinum Toxin: A Case Report. Neurol India 2020; 67:1110-1111. [PMID: 31512647 DOI: 10.4103/0028-3886.266235] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
Abstract
Jaw-opening oromandibular dystonia (O-OMD) is a clinical subtype of OMD, commonly resistant to treatment. Here, we report a distinct case of tardive O-OMD with a characteristic sensory trick, successfully treated with high-dose botulinum toxin (BTX) injection. A 34-year-old male patient presented with involuntary jaw opening, tongue protrusion, dysarthria, and mild cervical dystonia. The patient reported improved abilities to talk and close his mouth after putting something, like a cigarette, between his teeth. After an unsuccessful treatment with anticholinergic medications, the patient received electromyography-guided BTX injection to the lateral pterygoids (through an extraoral approach), sternocleidomastoids, trapezius, tongue, and platysma muscles. Following the injection, the patient reported marked improvements in his ability to talk and close his mouth without using his sensory trick. One month later, we detected a 58.2% improvement in the Abnormal Involuntary Movement Scale score. Therefore, high-dose BTX injection may be an effective alternative in refractory O-OMD.
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Affiliation(s)
- Ali S Shalash
- Department of Neurology, Faculty of Medicine, Ain Shams University, Cairo, Egypt
| | | | | | - Hanan Elrassas
- Department of Psychiatry, Faculty of Medicine, Ain Shams University, Cairo, Egypt
| | - Taha Kamel
- Department of Neurology, Faculty of Medicine, Ain Shams University, Cairo, Egypt
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Treatment of Tardive Dyskinesia: A General Overview with Focus on the Vesicular Monoamine Transporter 2 Inhibitors. Drugs 2019; 78:525-541. [PMID: 29484607 DOI: 10.1007/s40265-018-0874-x] [Citation(s) in RCA: 20] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/21/2022]
Abstract
Tardive dyskinesia (TD) encompasses the spectrum of iatrogenic hyperkinetic movement disorders following exposure to dopamine receptor-blocking agents (DRBAs). Despite the advent of atypical or second- and third-generation antipsychotics with a presumably lower risk of complications, TD remains a persistent and challenging problem. Prevention is the first step in mitigating the risk of TD, but early recognition, gradual withdrawal of offending medications, and appropriate treatment are also critical. As TD is often a persistent and troublesome disorder, specific antidyskinetic therapies are often needed for symptomatic relief. The vesicular monoamine transporter 2 (VMAT2) inhibitors, which include tetrabenazine, deutetrabenazine, and valbenazine, are considered the treatment of choice for most patients with TD. Deutetrabenazine-a deuterated version of tetrabenazine-and valbenazine, the purified parent product of one of the main tetrabenazine metabolites, are novel VMAT2 inhibitors and the only drugs to receive approval from the US FDA for the treatment of TD. VMAT2 inhibitors deplete presynaptic dopamine and reduce involuntary movements in many hyperkinetic movement disorders, particularly TD, Huntington disease, and Tourette syndrome. The active metabolites of the VMAT2 inhibitors have high affinity for VMAT2 and minimal off-target binding. Compared with tetrabenazine, deutetrabenazine and valbenazine have pharmacokinetic advantages that translate into less frequent dosing and better tolerability. However, no head-to-head studies have compared the various VMAT2 inhibitors. One of the major advantages of VMAT2 inhibitors over DRBAs, which are still being used by some clinicians in the treatment of some hyperkinetic disorders, including TD, is that they are not associated with the development of TD. We also briefly discuss other treatment options for TD, including amantadine, clonazepam, Gingko biloba, zolpidem, botulinum toxin, and deep brain stimulation. Treatment of TD and other drug-induced movement disorders must be individualized and based on the severity, phenomenology, potential side effects, and other factors discussed in this review.
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Bakke M, Henriksen T, Biernat HB, Dalager T, Møller E. Interdisciplinary recognizing and managing of drug-induced tardive oromandibular dystonia: two case reports. Clin Case Rep 2018; 6:2150-2155. [PMID: 30455910 PMCID: PMC6230632 DOI: 10.1002/ccr3.1548] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/18/2017] [Revised: 03/29/2018] [Accepted: 04/03/2018] [Indexed: 12/02/2022] Open
Abstract
Tardive dystonia is a risk factor in medical antipsychotic treatment. It often begins with repetitive involuntary jaw and tongue movements resulting in impaired chewing and detrimental effect on the dentition. The orofacial dysfunction may go unrecognized in a neurological setting. The diagnosis may be difficult so we suggest interdisciplinary collaboration.
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Affiliation(s)
- Merete Bakke
- Department of Odontology Faculty of Medical and Health Sciences University of Copenhagen Copenhagen Denmark
| | - Tove Henriksen
- Department of Neurology and Clinical Neurophysiology (Dystonia Clinic) Bispebjerg University Hospital University of Copenhagen Copenhagen Denmark
| | - Heidi Bryde Biernat
- Department of Neurology and Clinical Neurophysiology (Dystonia Clinic) Bispebjerg University Hospital University of Copenhagen Copenhagen Denmark
| | - Torben Dalager
- Department of Neurology and Clinical Neurophysiology (Dystonia Clinic) Bispebjerg University Hospital University of Copenhagen Copenhagen Denmark
| | - Eigild Møller
- Department of Neurology and Clinical Neurophysiology (Dystonia Clinic) Bispebjerg University Hospital University of Copenhagen Copenhagen Denmark
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Scorr LM, Silver MR, Hanfelt J, Sperin E, Freeman A, Jinnah HA, Factor SA. Pilot Single-Blind Trial of AbobotulinumtoxinA in Oromandibular Dystonia. Neurotherapeutics 2018; 15:452-458. [PMID: 29542022 PMCID: PMC5935649 DOI: 10.1007/s13311-018-0620-9] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/21/2022] Open
Abstract
Oromandibular dystonia (OMD) causes involuntary movements of masticatory and lingual muscles impairing eating, speaking, and swallowing. Treatment options are limited. The objective of this study was to determine the safety and efficacy of abobotulinumtoxinA (aboBoNTA) in OMD. A dose-finding study (phase 1) followed by a single session, prospective, single-blind trial (phase 2) was carried out. OMD subjects were evaluated at baseline, 6 and 12 weeks. Muscles injected were tailored to individual symptoms using EMG guidance, but the aboBoNTA dose for each muscle was pre-specified based on phase 1 results. Evaluations were Global Dystonia Rating Scale (GDS), Unified Dystonia Rating Scale (UDRS), Clinical Global Impression (CGI) improvement and severity, and quality of life (OMDQ-25). Adverse events were monitored. The lowest dosage in phase 1 resulted in adverse effects in two of three patients and thus was used in phase 2. In phase 2, adverse effects were observed in 50% of subjects including dysphagia, voice change, and soft palate weakness. Most were mild. Significant improvement was seen in quality of life (OMDQ-25), speech (BFMq21), and change in GDS, UDRS, CGI severity assessed by the unblinded investigator, but not in blinded video ratings. We conclude that aboBoNTA therapy in this study was associated with improved quality of life and was generally well tolerated in OMD, but occurrence of dysphagia dictated the importance of using low genioglossus dosing. Face to face assessment appears to be more sensitive than video assessment for change in OMD severity. Consideration of the disability in OMD places constraints on traditional placebo-control trial design. Development of novel trial designs is warranted.
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Affiliation(s)
- Laura M Scorr
- Department of Neurology, Emory University, Atlanta, GA, USA
| | | | - John Hanfelt
- Department of Biostatistics and Bioinformatics, Emory University, Atlanta, GA, USA
| | - Elaine Sperin
- Department of Neurology, Emory University, Atlanta, GA, USA
| | - Alan Freeman
- Department of Neurology, Emory University, Atlanta, GA, USA
| | - H A Jinnah
- Department of Neurology, Emory University, Atlanta, GA, USA
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Yoshida K. Clinical and Phenomenological Characteristics of Patients with Task-Specific Lingual Dystonia: Possible Association with Occupation. Front Neurol 2017; 8:649. [PMID: 29321757 PMCID: PMC5732148 DOI: 10.3389/fneur.2017.00649] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/24/2017] [Accepted: 11/17/2017] [Indexed: 11/16/2022] Open
Abstract
BACKGROUND Lingual dystonia is a subtype of oromandibular dystonia, which is a movement disorder characterized by involuntary sustained or intermittent contraction of the masticatory and/or tongue muscles. Lingual dystonia interferes with important daily activities, such as speaking, chewing, and swallowing, resulting in vocational and social disability. OBJECTIVE The aim of this study was to investigate a possible relationship between occupation and the development of lingual dystonia. METHODS Phenomenological and clinical characteristics of 95 patients [53 females (55.8%) and 42 males (44.2%), mean age 48.0 years] with task-specific, speech-induced lingual dystonia were analyzed. Structured interviews were carried out to obtain information regarding primary occupation, including overtime work and stress during work. The factors that might have influenced the development of lingual dystonia were estimated using multivariate logistic regression analysis of the 95 patients with lingual dystonia and 95 controls [68 females (71.6%) and 27 males (28.4%), mean age 47.2 years] with temporomandibular disorders. RESULTS Overall, 84.2% of the patients had regular occupations; 73.8% of the patients with regular occupations reported working overtime more than twice a week, and 63.8% of them experienced stress at the workplace. Furthermore, 82.1% of the patients had engaged in occupations that required them to talk to customers or other people under stressful situations over prolonged periods of time for many years (mean: 15.6 years). The most common occupation was sales representative (17.9%), followed by telephone operator (13.7%), customer service representative (10.5%), health care worker (9.5%), waiter or waitress (5.3%), receptionist (5.3%), and cashier (5.3%). Twenty-nine patients (30.5%) had tardive lingual dystonia. Logistic regression analyses revealed that frequent requirements for professional speaking (p = 0.011, odds ratio: 5.66), high stress during work (p = 0.043, odds ratio: 5.4), and neuroleptic use (p = 0.032, odds ratio: 2.52) were significant contributors to the manifestation of lingual dystonia. CONCLUSION Professions in which conversations in stressful situations are unavoidable may trigger lingual dystonia. Therefore, speech-induced lingual dystonia can be regarded as occupational dystonia in certain cases.
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Affiliation(s)
- Kazuya Yoshida
- Department of Oral and Maxillofacial Surgery, National Hospital Organization, Kyoto Medical Center, Kyoto, Japan
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22
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Page AD, Siegel L, Jog M. Self-Rated Communication-Related Quality of Life of Individuals With Oromandibular Dystonia Receiving Botulinum Toxin Injections. AMERICAN JOURNAL OF SPEECH-LANGUAGE PATHOLOGY 2017; 26:674-681. [PMID: 28654948 DOI: 10.1044/2017_ajslp-16-0098] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/14/2016] [Accepted: 11/29/2016] [Indexed: 06/07/2023]
Abstract
PURPOSE In this preliminary study, we examined self-rated communication-related quality of life (CR-QoL) of 10 control participants and 10 individuals with oromandibular dystonia (OMD) and dysarthria receiving therapeutic botulinum toxin (BoNT-A) injections. METHOD Participants with OMD and associated dysarthria self-rated CR-QoL pre- and post- BoNT-A injection using the American Speech-Language-Hearing Association's Quality of Communication Life Scale (ASHA QCL; Paul et al., 2004). Control participants self-rated CR-QoL during a single experimental visit. RESULTS Significant differences were found between control participants and participants with OMD on ratings of CR-QoL across all 5 domains and subdomains of the ASHA QCL. No significant differences in CR-QoL were found over the course of the BoNT-A treatment cycle. CONCLUSIONS CR-QoL was rated lower by participants with OMD as compared with control participants across all ASHA QCL domains/subdomains with "socialization/activities" and "confidence/self-concept" having the largest effect sizes. No differences in CR-QoL were found over the course of the treatment cycle. We advocate for outcome measures that include patient report. The use of patient-reported outcome measures in conjunction with objective or impairment-based outcome measures can help inform meaningful clinical indicators of treatment success. This study adds novel information that may aid our understanding of the experience of living with OMD in this underserviced clinical population.
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Affiliation(s)
- Allyson D Page
- School of Communication Sciences and Disorders, Western University, London, ON, CanadaHealth and Rehabilitation Sciences, Western University, London, ON, Canada
| | - Lauren Siegel
- Health and Rehabilitation Sciences, Western University, London, ON, Canada
| | - Mandar Jog
- Department of Clinical Neurological Sciences, Western University, London, ON, Canada
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Management of oromandibular dystonia with botulinum A toxin: a series of cases. Br J Oral Maxillofac Surg 2016; 54:1080-1084. [DOI: 10.1016/j.bjoms.2016.06.028] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/05/2016] [Accepted: 06/28/2016] [Indexed: 11/23/2022]
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Abstract
Despite numerous case reports, the evidence for treatment of bruxism is still low. Different treatment modalities (behavioral techniques, intraoral devices, medications, and contingent electrical stimulation) have been applied. A clinical evaluation is needed to differentiate between awake bruxism and sleep bruxism and rule out any medical disorder or medication that could be behind its appearance (secondary bruxism). A polysomnography is required only in a few cases of sleep bruxism, mostly when sleep comorbidities are present. Counselling with regard to sleep hygiene, sleep habit modification, and relaxation techniques has been suggested as the first step in the therapeutic intervention, and is generally considered not harmful, despite low evidence of any efficacy. Occlusal splints are successful in the prevention of dental damage and grinding sounds associated with sleep bruxism, but their effects on reducing bruxism electromyographic (EMG) events are transient. In patients with psychiatric and sleep comorbidities, the acute use of clonazepam at night has been reported to improve sleep bruxism, but in the absence of double-blind randomized trials, its use in general clinical practice cannot be recommended. Severe secondary bruxism interfering with speaking, chewing, or swallowing has been reported in patients with neurological disorders such as in cranial dystonia; in these patients, injections of botulinum toxin in the masticatory muscles may decrease bruxism for up to 1–5 months and improve pain and mandibular functions. Long-term studies in larger and better specified samples of patients with bruxism, comparing the effects of different therapeutic modalities on bruxism EMG activity, progression of dental wear, and orofacial pain are current gaps of knowledge and preclude the development of severity-based treatment guidelines.
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Affiliation(s)
- Marc Guaita
- Department of Neurology, Medical University of Innsbruck, Anichstrasse 35, 6020, Innsbruck, Austria
| | - Birgit Högl
- Department of Neurology, Medical University of Innsbruck, Anichstrasse 35, 6020, Innsbruck, Austria.
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Abstract
INTRODUCTION Drug-induced movement disorders (DIMDs) can be elicited by several kinds of pharmaceutical agents. The major groups of offending drugs include antidepressants, antipsychotics, antiepileptics, antimicrobials, antiarrhythmics, mood stabilisers and gastrointestinal drugs among others. AREAS COVERED This paper reviews literature covering each movement disorder induced by commercially available pharmaceuticals. Considering the magnitude of the topic, only the most prominent examples of offending agents were reported in each paragraph paying a special attention to the brief description of the pathomechanism and therapeutic options if available. EXPERT OPINION As the treatment of some DIMDs is quite challenging, a preventive approach is preferable. Accordingly, the use of the offending agents should be strictly limited to appropriate indications and they should be applied in as low doses and as short duration as the patient's condition allows. As most of DIMDs are related to an unspecific adverse action of medications in the basal ganglia and the cerebellum, future research should focus on better characterisation of the neurochemical profile of the affected functional systems, in addition to the development of drugs with higher selectivity and better side-effect profile.
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Affiliation(s)
- Dénes Zádori
- University of Szeged, Albert Szent-Györgyi Clinical Center, Department of Neurology, Faculty of Medicine , Semmelweis u. 6, H-6725 Szeged , Hungary +36 62 545351 ; +36 62 545597 ;
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Moscovich M, Chen ZP, Rodriguez R. Successful treatment of open jaw and jaw deviation dystonia with botulinum toxin using a simple intraoral approach. J Clin Neurosci 2014; 22:594-6. [PMID: 25541097 DOI: 10.1016/j.jocn.2014.08.027] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/18/2014] [Accepted: 08/25/2014] [Indexed: 11/29/2022]
Abstract
Oromandibular dystonia (OMD) is a focal dystonia that involves the mouth, jaw, and/or tongue. It can be classified as idiopathic, tardive dystonia or secondary to other neurological disorders and subdivided into jaw opening, jaw closing, jaw deviation and lip pursing. The muscles involved in jaw opening dystonia are usually the digastrics and lateral pterygoids. It is known that the lateral pterygoids may be approached both internally and externally. The external approach is the most common; however neurologists experienced in treating patients with botulinum toxin can safely and with no extra cost perform the intraoral procedure. We report our experience in the treatment of jaw opening and jaw deviation dystonia using the intraoral injection approach. Eight patients were selected from the University of Florida with a clinical diagnosis of open jaw/jaw deviation dystonia. All of them were injected with onabotulinum toxin A using the internal approach and the clinical global impression scale was applied. The mean age of the patients was 67 (standard deviation [SD] 10.2) years, with a disease duration of 10.2 (SD 7.7) years and the mean distance they traveled to our institution was 448 km (278 miles). After treatment, six patients scored as very much improved in the clinical global impression scale and two patients scored as much improved. Only one patient reported an adverse event of nasal speech following one of the injections that improved after 4 weeks. Botulinum toxin injections for open jaw/jaw deviation dystonia can be safely performed with the intraoral approach without the need of special devices other than electromyography.
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Affiliation(s)
- Mariana Moscovich
- Department of Neurology, University of Florida, Center for Movement Disorders & Neurorestoration, McKnight Brain Institute, 3450 Hull Road, 4th floor, Gainesville, FL 32607, USA
| | - Zhongxing Peng Chen
- Department of Neurology, University of Florida, Center for Movement Disorders & Neurorestoration, McKnight Brain Institute, 3450 Hull Road, 4th floor, Gainesville, FL 32607, USA
| | - Ramon Rodriguez
- Department of Neurology, University of Florida, Center for Movement Disorders & Neurorestoration, McKnight Brain Institute, 3450 Hull Road, 4th floor, Gainesville, FL 32607, USA.
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Alshadwi A, Nadershah M, Osborn T. Therapeutic applications of botulinum neurotoxins in head and neck disorders. Saudi Dent J 2014; 27:3-11. [PMID: 25544809 PMCID: PMC4273262 DOI: 10.1016/j.sdentj.2014.10.001] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/31/2013] [Revised: 08/18/2014] [Accepted: 10/20/2014] [Indexed: 11/06/2022] Open
Abstract
Objective The aim of this article is to review the mechanism of action, physiological effects, and therapeutic applications of botulinum neurotoxins in the head and neck area. Study design An extensive literature search was performed using keywords. The resulting articles were analyzed for relevance in four areas: overview on botulinum neurotoxins, the role of botulinum neurotoxins in the management of salivary secretory disorders, the role of botulinum neurotoxins in the management of facial pain, and the role of botulinum neurotoxins in head and neck movement disorders. Institutional review board approval was not needed due the nature of the study. Results Botulinum neurotoxin therapy was demonstrated to be a valuable alternative to conventional medical therapy for many conditions affecting the head and neck area in terms of morbidly, mortality, and patient satisfaction with treatment outcomes. Conclusion Botulinum neurotoxin therapy provides viable alternatives to traditional treatment modalities for some conditions affecting the head and neck region that have neurological components. This therapy can overcome some of the morbidities associated with conventional therapy. More research is needed to determine the ideal doses of botulinum neurotoxin to treat different diseases affecting the head and neck regions.
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Affiliation(s)
- Ahmad Alshadwi
- Department of Oral and Maxillofacial Surgery, Boston University-Henry M. Goldman School of Dental Medicine, 100 East Newton Street, Suite G-407, Boston, MA 02118, United States ; King Feisal Specialist Hospital and Research Centre, Riyadh, Saudi Arabia
| | - Mohammed Nadershah
- Academic Faculty King Abdulaziz University-Dental School, Jeddah, Saudi Arabia
| | - Timothy Osborn
- Department of Oral and Maxillofacial Surgery, Boston University-Henry M. Goldman School of Dental Medicine, 100 East Newton Street, Suite G-407, Boston, MA 02118, United States
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Termsarasab P, Tanenbaum DR, Frucht SJ. The phenomenology and natural history of idiopathic lower cranial dystonia. JOURNAL OF CLINICAL MOVEMENT DISORDERS 2014; 1:3. [PMID: 26788329 PMCID: PMC4676493 DOI: 10.1186/2054-7072-1-3] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 03/28/2014] [Accepted: 05/07/2014] [Indexed: 12/12/2022]
Abstract
Background Many patients with lower cranial dystonia (LCrD) are misdiagnosed, and recognition of this condition by general practitioners and dental health professionals is limited. Methods We define the phenomenology and natural history of idiopathic LCrD, presenting in 41 patients with the disorder, the largest series of these patients reported to date. Results Phenomenology of dystonia included lower cranial and pharyngeal involvement, jaw opening and jaw closing dystonia, and tongue dystonia. Of 25 newly described patients, 72% (18) were female, average age at onset was 56 years, and delay before correct diagnosis was 3.8 years (0-25 years, median 2 years). Eleven patients (44%) reported a precipitating event, the most common of which was recent dental work. Geste antagonistes were found in 18 patients (72%). Response to treatment was mixed, indicating an unmet therapeutic need. Conclusions Idiopathic LCrD is often missed and institution of effective therapy is often delayed. The clinical features and natural history of LCrD are similar to other forms of focal dystonia. Electronic supplementary material The online version of this article (doi:10.1186/2054-7072-1-3) contains supplementary material, which is available to authorized users.
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Affiliation(s)
- Pichet Termsarasab
- Department of Neurology, Movement Disorders Division, Icahn School of Medicine at Mount Sinai, 5 East 98th St, first floor, New York, NY 10029 USA
| | - Donald R Tanenbaum
- Department of Neurology, Movement Disorders Division, Icahn School of Medicine at Mount Sinai, 5 East 98th St, first floor, New York, NY 10029 USA
| | - Steven J Frucht
- Department of Neurology, Movement Disorders Division, Icahn School of Medicine at Mount Sinai, 5 East 98th St, first floor, New York, NY 10029 USA
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Oromandibular dystonia secondary to radiation therapy: a description of 2 cases. NEUROLOGÍA (ENGLISH EDITION) 2014. [DOI: 10.1016/j.nrleng.2014.02.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022] Open
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Distonía oromandibular secundaria a radioterapia: descripción de 2 casos. Neurologia 2014; 29:189-91. [DOI: 10.1016/j.nrl.2012.05.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/27/2012] [Revised: 05/21/2012] [Accepted: 05/28/2012] [Indexed: 11/18/2022] Open
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de Oliveira RH, Hallak JEC, Siéssere S, de Sousa LG, Semprini M, de Sena MF, Osorio FDL, Nunes EA, Pinto JP, Regalo SCH. Electromyographic analysis of masseter and temporal muscles, bite force, masticatory efficiency in medicated individuals with schizophrenia and mood disorders compared with healthy controls. J Oral Rehabil 2014; 41:399-408. [PMID: 24661123 DOI: 10.1111/joor.12164] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 02/26/2014] [Indexed: 12/21/2022]
Abstract
This study aimed to comparatively analyse the electromyographic activity of the masseter and temporal muscles at rest and during mandible postural clinical conditions (right and left laterality, protrusion and maximum voluntary contraction), right and left maximum molar bite forces and the masticatory efficiency of individuals with schizophrenia or mood disorders - all medicated (medicated groups) compared with control group (healthy volunteers) via electromyography. Individuals were distributed into three groups: Group I (Schizophrenia - 20 individuals), Group II (mood disorders - 20 individuals) and Group III (Control - 40 individuals). Basically, the results were only statistically significant for the clinical mandible conditions and bite force. The most unsatisfactory results were observed in the medicated groups in relation to the control group. The group with mood disorders obtained the most unsatisfactory results compared with the group with schizophrenia. It was suggested by these observations that the association of mood disorders and schizophrenia with medication has negatively affected the stomatognathic system in relation to controls when the electromyography and bite force were used for the analysis.
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Affiliation(s)
- R H de Oliveira
- Departament of Morphology, Physiology and Basic Pathology, School of Dentistry of Ribeirão Preto, University of São Paulo and INCT Translational Medicine (CNPq), Ribeirão Preto, Brazil
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Tano O, Kaneko K, Kikuchi A, Hasegawa T, Takeda A, Aoki M. [Dopaminergic drug-induced jaw-opening dystonia in a patient with progressive supranuclear palsy]. Rinsho Shinkeigaku 2013; 53:308-311. [PMID: 23603547 DOI: 10.5692/clinicalneurol.53.308] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/02/2023]
Abstract
A 74 year-old man with progressive supranuclear palsy (PSP) was adimitted to our hospital. He developed bradykinesia 13 years previously. Neurological examination showed cognitive dysfunction, supranuclear vertical gaze palsy, pseudobulbar palsy, and parkinsonism such as akinesia, rigidity, and resting tremor. His chief complaint was glossoptosis with jaw-opening dystonia associated with rapid dose-elevation and/or overdose of dopaminergic drugs. After gradual tapering of dopaminergic drugs, he could keep his mouth closed all day. Drug-induced dystonia is a frequently encountered but often overlooked symptom of neurological disorders. The motor symptoms of PSP sometimes respond to dopamine replacement therapy; however, it should be kept in mind that rapid dose-elevation and/or overdose of dopaminergic agents may cause jaw-opening dystonia.
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Affiliation(s)
- Ohito Tano
- Department of Neurology, Tohoku University School of Medicine
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Steeves TD, Day L, Dykeman J, Jette N, Pringsheim T. The prevalence of primary dystonia: A systematic review and meta-analysis. Mov Disord 2012; 27:1789-96. [DOI: 10.1002/mds.25244] [Citation(s) in RCA: 223] [Impact Index Per Article: 18.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/14/2012] [Revised: 07/14/2012] [Accepted: 09/20/2012] [Indexed: 01/21/2023] Open
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Jang SM, Cho YC, Sung IY, Kim SY, Son JH. Oromandibular dystonia after dental treatments: a report of two cases. J Korean Assoc Oral Maxillofac Surg 2012. [DOI: 10.5125/jkaoms.2012.38.6.379] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/07/2022] Open
Affiliation(s)
- Soo-Mi Jang
- Department of Oral and Maxillofacial Surgery, Ulsan University Hospital, College of Medicine, Ulsan University, Ulsan, Korea
| | - Yeong-Cheol Cho
- Department of Oral and Maxillofacial Surgery, Ulsan University Hospital, College of Medicine, Ulsan University, Ulsan, Korea
| | - Iel-Yong Sung
- Department of Oral and Maxillofacial Surgery, Ulsan University Hospital, College of Medicine, Ulsan University, Ulsan, Korea
| | - Sun-Young Kim
- Department of Neurology, Ulsan University Hospital, College of Medicine, Ulsan University, Ulsan, Korea
| | - Jang-Ho Son
- Department of Oral and Maxillofacial Surgery, Ulsan University Hospital, College of Medicine, Ulsan University, Ulsan, Korea
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Maciel ROH, Pedroso JL, Barsottini OGP. Facial grimacing as a clue for the diagnosis of GM1 type 3 gangliosidosis. ARQUIVOS DE NEURO-PSIQUIATRIA 2011; 69:406-7. [PMID: 21625776 DOI: 10.1590/s0004-282x2011000300028] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/21/2022]
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Abstract
Tardive dystonia is a side effect of dopamine receptor-blocking agents, which are mainly used as antipsychotic drugs. The treatment of tardive dystonia is difficult and often unsuccessful. An 82-year-old woman experienced mandibular deviation to the left due to spasm of the masticatory muscles with involuntary chewing movement and Parkinsonism. She had been treated with sulpiride for motility disorder for 5 years. Parkinsonism almost disappeared after the withdrawal of sulpiride, but tardive oromandibular dystonia showed no improvement. Aripiprazole treatment at 3 mg/day improved tardive oromandibular dystonia without worsening Parkinsonism. Low-dosage aripiprazole may be effective for tardive oromandibular dystonia in patients with no other psychiatric disorder.
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Affiliation(s)
- Noboru Imai
- Department of Neurology, Shizuoka Red Cross Hospital, Japan.
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Abstract
Dystonia is defined as involuntary sustained muscle contractions producing twisting or squeezing movements and abnormal postures. The movements can be stereotyped and repetitive and they may vary in speed from rapid to slow; sustained contractions can result in fixed postures. Dystonic disorders are classified into primary and secondary forms. Several types of adult-onset primary dystonia have been identified but all share the characteristic that dystonia (including tremor) is the sole neurologic feature. The forms most commonly seen in neurological practice include cranial dystonia (blepharospasm, oromandibular and lingual dystonia and spasmodic dysphonia), cervical dystonia (also known as spasmodic torticollis) and writer's cramp. These are the disorders that benefit most from botulinum toxin injections. A general characteristic of dystonia is that the movements or postures may occur in relation to specific voluntary actions by the involved muscle groups (such as in writer's cramp). Dystonic contractions may occur in one body segment with movement of another (overflow dystonia). With progression, dystonia often becomes present at rest. Dystonic movements typically worsen with anxiety, heightened emotions, and fatigue, decrease with relaxation, and disappear during sleep. There may be diurnal fluctuations in the dystonia, which manifest as little or no involuntary movement in the morning followed by severe disabling dystonia in the afternoon and evening. Morning improvement (or honeymoon) is seen with several types of dystonia. Patients often discover maneuvers that reduce the dystonia and which involve sensory stimuli such as touching the chin lightly in cervical dystonia. These maneuvers are known as sensory tricks, or gestes antagonistes. This chapter focuses on adult-onset focal dystonias including cranial dystonia, cervical dystonia, and writer's cramp. The chapter begins with a review of the epidemiology of focal dystonias, followed by discussions of each major type of focal dystonia, covering clinical phenomenology, differential genetics, and diagnosis. The chapter concludes with discussions of the pathophysiology, the few pathological cases published of adult-onset focal dystonia and management options, and a a brief look at the future.
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Affiliation(s)
- Marian L Evatt
- Department of Neurology, Emory University School of Medicine, Atlanta, GA 30322, USA
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De Riu G, Sanna MP, De Riu PL. An elderly female patient with tardive oromandibular dystonia after prolonged use of the histamine analog betahistine. J Clin Neurosci 2010; 17:1330-1. [PMID: 20594853 DOI: 10.1016/j.jocn.2010.01.034] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/26/2009] [Revised: 01/07/2010] [Accepted: 01/11/2010] [Indexed: 10/19/2022]
Abstract
Tardive oromandibular dystonia (OMD) is iatrogenic in origin and is characterised by orofacial and lingual stereotypes more frequently than the idiopathic form of OMD Tardive OMD is often associated with anti-dopaminergic treatment involving drugs such as anti-psychotics, anti-emetics, and anti-vertigo agents, although the syndrome can also be triggered by anti-epileptic or anti-depressant drugs that do not have anti-dopaminergic properties. We report an elderly female patient with OMD after prolonged, self-administered treatment with betahistine dihydrochloride, a histamine analogue.
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Affiliation(s)
- G De Riu
- Department of Maxillofacial Surgery, Viale San Pietro 43/b, University of Sassari, 07100 Sassari, Italy.
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Esper CD, Freeman A, Factor SA. Lingual protrusion dystonia: frequency, etiology and botulinum toxin therapy. Parkinsonism Relat Disord 2010; 16:438-41. [PMID: 20494607 DOI: 10.1016/j.parkreldis.2010.04.007] [Citation(s) in RCA: 41] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/10/2010] [Accepted: 04/19/2010] [Indexed: 10/19/2022]
Abstract
The purpose of this study was to examine lingual protrusion dystonia (LPD); its frequency, etiology and response to botulinum toxin therapy. Previous literature suggests that LPD is more frequently the result of heredodegenerative disease and that the use of botulinum toxin therapy in LPD is associated with significant adverse effects. This is a retrospective database and record review from a movement disorder clinic. Of 421 dystonia patients, we identified 17 with LPD (4%). Of these cases, the diagnoses were: primary cranial dystonia (5), primary generalized dystonia (2), tardive dystonia (7), heredodegenerative disease (1), multifactorial (1) and post-infectious (1). All primary cases had concomitant oromandibular dystonia. In some secondary cases the LPD was the only cranial feature. Nine received botulinum toxin injections and 55.6% sustained moderate or marked improvement. Of 89 total botulinum toxin sessions, 66.3% had an excellent response, and 92.1% had some response. 97.8% of the sessions resulted in no significant adverse effects. On one occasion one patient developed severe dysphagia requiring placement of a percutaneous gastrostomy (PEG) tube. We conclude that LPD is rare, most commonly the result of tardive and primary dystonia. Botulinum toxin therapy may be very effective but needs to be utilized with care because of the possibility for the development of dysphagia.
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Affiliation(s)
- Christine D Esper
- Emory University School of Medicine, Department of Neurology, Movement Disorders Program, Atlanta, GA 30329, USA
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Reichel G, Stenner A. Behandlung lingualer Dystonie mit Botulinum-Toxin-Injektionen. DER NERVENARZT 2009; 80:959-62. [DOI: 10.1007/s00115-009-2713-5] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
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Schramm A, Classen J, Naumann M. Tricking a patient with oromandibular dystonia. Mov Disord 2008. [DOI: 10.3109/9780203008454-65] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
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Management of dystonia of the lateral pterygoid muscle with botulinum toxin A. Br J Oral Maxillofac Surg 2008; 47:481-3. [PMID: 18829144 DOI: 10.1016/j.bjoms.2008.08.010] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 08/21/2008] [Indexed: 11/20/2022]
Abstract
Oromandibular dystonia (OMD) is a rare neurological condition infrequently seen by oral and maxillofacial surgeons which may result in inappropriate deviation of the mandible, subluxation and intraoral soft tissue trauma. A case is presented of a patient suffering from spasmodic torticollis and lateral pterygoid dystonia and currently under treatment with botulinum A toxin (Botox) injections. Botox has emerged as the most effective form of symptomatic treatment for abnormabilities in muscle movement, namely dystonia with oromandibular symptoms.
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Abstract
Dystonia is a syndrome of involuntary, repetitive (or sustained) muscle contractions of opposing muscles, which may result in torsions and abnormal postures. Tardive dystonia is a form of the disorder that starts after longer term use of dopamine antagonists. It occurs in approximately 3% of patients receiving ongoing antipsychotic treatment and is often difficult to reverse. Dystonia can also be induced by compounds other than antipsychotics, such as antidepressants, levodopa, carbamazepine, dextroamphetamine, and diphenylhydantoin. In these cases, it is transient, generally disappearing after the dose is reduced or the causative drug is stopped. Dystonia induced by injury can also be transient. We report a case of transient oromandibular dystonia following a dental filling in a woman receiving quetiapine, a second-generation antipsychotic. The timing, localization, and transience of the dystonia suggested that the dental procedure may have played a triggering role. The dystonia symptoms responded within 8 weeks to benztropine and a dose reduction of quetiapine, and they did not return when benztropine was discontinued. This case benefited from prompt attention and has led to practical recommendations for psychiatric clinicians.
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Abstract
This article reviews three poorly recognized yet relatively common presentations of hyperactive orofacial movement disorders: oromandibular dystonia, orofacial dyskinesia, and drug-induced extrapyramidal syndrome reactions. Orofacial movement disorders are often misdiagnosed as temporomandibular disorders, hence understanding these conditions is pertinent for the practitioner treating orofacial pain. Aspects of epidemiology, etiology, pathophysiology, clinical presentation, and diagnosis are discussed along with treatment considerations for these orofacial movement disorders.
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Affiliation(s)
- Ramesh Balasubramaniam
- Department of Oral Medicine, University of Pennsylvania, School of Dental Medicine, 240 South 40th Street, Philadelphia, PA 19104, USA.
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Balasubramaniam R, Rasmussen J, Carlson LW, Van Sickels JE, Okeson JP. Oromandibular Dystonia Revisited: A Review and a Unique Case. J Oral Maxillofac Surg 2008; 66:379-86. [DOI: 10.1016/j.joms.2006.11.028] [Citation(s) in RCA: 21] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/25/2006] [Revised: 10/21/2006] [Accepted: 11/16/2006] [Indexed: 10/22/2022]
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49
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Lee KH. Oromandibular dystonia. ACTA ACUST UNITED AC 2007; 104:491-6. [PMID: 17689275 DOI: 10.1016/j.tripleo.2007.04.001] [Citation(s) in RCA: 25] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/05/2006] [Revised: 02/12/2007] [Accepted: 04/02/2007] [Indexed: 10/23/2022]
Abstract
Oromandibular dystonia (OMD) is a rare neuromuscular disorder characterized by involuntary repetitive muscular contraction affecting different parts of the oromandibular region. Its various physical manifestations can be extremely debilitating and socially disabling to affected patients. To date, there is no commonly accepted set of diagnostic criteria nor well-defined management pathways. This paper aims to discuss some aspects of clinical manifestations, diagnostic criteria, neurological mechanisms, and treatment options for OMD, with illustrations from 6 clinical cases.
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Affiliation(s)
- Kai H Lee
- Department of Oral and Maxillofacial Surgery, Oral Health Center, Canterbury Hospital, Christchurch, New Zealand.
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50
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Abstract
Geste antagonistes, or sensory tricks, are well described in focal dystonia affecting the neck, hand, and face. Improvement in dystonic movements is typically maintained while the trick is performed, but disappears when the geste ends. We investigated the phenomenological features of geste antagoniste maneuvers in 19 patients with idiopathic lower cranial dystonia who were prospectively evaluated over a period of 6 years. Of the 19, 10 were men, mean age of onset was 49.8 years, and the most commonly involved lower cranial area was the jaw (10 patients). In most patients, dystonia was task-specific. Taking advantage of the improvement with a sensory geste, we manufactured oral appliances that mimicked the geste in 8 patients, and 3 continue to use it.
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Affiliation(s)
- Steven E Lo
- The Neurological Institute, Columbia University Medical Center, New York, New York, USA
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