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Barad NH, Mulroy E. Successful treatment of cranial dystonia using a Zolpidem+Melatonin combination: A video case-series. J Neurol Sci 2024; 460:122986. [PMID: 38583390 DOI: 10.1016/j.jns.2024.122986] [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: 01/21/2024] [Revised: 03/13/2024] [Accepted: 03/31/2024] [Indexed: 04/09/2024]
Abstract
INTRODUCTION Cranial dystonias (CrD) are challenging to treat. Oral pharmacotherapy is often sub-optimal, while delicate anatomy and limited availability of skilled botulinum toxin injectors makes this approach risky, and often difficult to access; neurosurgical options e.g. deep brain stimulation, are high-risk in the elderly populations most affected. We observed significant improvement in CrD in 2 patients prescribed Zolpidem+Melatonin combination treatment for insomnia, and therefore trialled this treatment in a further 4 patients with CrD. METHODS Six patients were treated with Zolpidem+Melatonin. Pre- and post-treatment videotaped clinical examinations were blindly rated by an independent assessor (EM) and scored using the 'Facial and Oral Movements' section of the abnormal involuntary movements scale (AIMS), as well as the Jankovic rating scale for blepharospasm. RESULTS Dystonic features, as measured by the abnormal involuntary movements scale (AIMS) improved by an average of 75% after treatment (6.5±3.1 before treatment to 1.7 +/- 0.8 after treatment). Improvements were also observed in blepharospasm severity scores, and in cervical dystonic features. CONCLUSION Zolpidem+Melatonin combination treatment represents a safe and effective treatment for CrD. Low cost and wide availability makes it an attractive option, particularly in resource-constrained healthcare settings, or in patients who have failed, or lack access to alternatives.
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Affiliation(s)
- Narendrakumar H Barad
- Department of Functional Neurosciences, Marengo Cims Hospital, Ahmedabad, Gujarat 380060, India
| | - Eoin Mulroy
- Department of Clinical and Movement Neurosciences, UCL Queen Square Institute of Neurology, London WC1N 3BG, United Kingdom.
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Valencia Uribe J, Hossain N, Rizvi H, Qureshi M. A Presentation of Meige Syndrome With Associated Upper Motor Neuron Symptoms. Cureus 2024; 16:e60101. [PMID: 38860087 PMCID: PMC11163852 DOI: 10.7759/cureus.60101] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 05/11/2024] [Indexed: 06/12/2024] Open
Abstract
Meige syndrome (MS) is a cranial dystonia that involves blepharospasm and oromandibular dystonia. It can also evolve to include other adjacent muscle groups in the cervical region. It typically presents in middle-aged females, and while the disorder is relatively uncommon, its exact prevalence varies. Diagnosis is typically made with a thorough history and physical and workup to rule out other causes. Treatment options include medical management with gamma-aminobutyric acid (GABA) antagonists, dopamine antagonists, and anticholinergics for short-term management. Long-term treatment options are Botox and deep brain stimulation. This case report presents a 56-year-old female with a complex presentation of MS; the patient's symptoms progressed from isolated blepharospasms to involve orofacial and cervical musculature. A distinctive aspect of this case was the simultaneous presence of upper motor neuron (UMN) signs in the patient alongside acute to subacute compression fractures of the superior endplate of C7 and T3, as revealed by cervical spine imaging. Treatment with clonazepam led to significant symptomatic improvement, highlighting the importance of a multimodal approach in managing MS. This case underscores the need for careful clinical evaluation, collaboration with movement disorder specialists, and ongoing research efforts to enhance understanding and treatment of MS.
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Affiliation(s)
| | - Nazia Hossain
- Internal Medicine, Memorial Healthcare System, Pembroke Pines, USA
| | - Hassnain Rizvi
- Neurology, Memorial Healthcare System, Pembroke Pines, USA
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Xu J, Luo Y, Zhang J, Zhong L, Liu H, Weng A, Yang Z, Zhang Y, Ou Z, Yan Z, Cheng Q, Fan X, Zhang X, Zhang W, Hu Q, Liang D, Peng K, Liu G. Progressive thalamic nuclear atrophy in blepharospasm and blepharospasm-oromandibular dystonia. Brain Commun 2024; 6:fcae117. [PMID: 38638150 PMCID: PMC11025674 DOI: 10.1093/braincomms/fcae117] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/30/2023] [Revised: 01/21/2024] [Accepted: 04/05/2024] [Indexed: 04/20/2024] Open
Abstract
The thalamus is considered a key region in the neuromechanisms of blepharospasm. However, previous studies considered it as a single, homogeneous structure, disregarding potentially useful information about distinct thalamic nuclei. Herein, we aimed to examine (i) whether grey matter volume differs across thalamic subregions/nuclei in patients with blepharospasm and blepharospasm-oromandibular dystonia; (ii) causal relationships among abnormal thalamic nuclei; and (iii) whether these abnormal features can be used as neuroimaging biomarkers to distinguish patients with blepharospasm from blepharospasm-oromandibular dystonia and those with dystonia from healthy controls. Structural MRI data were collected from 56 patients with blepharospasm, 20 with blepharospasm-oromandibular dystonia and 58 healthy controls. Differences in thalamic nuclei volumes between groups and their relationships to clinical information were analysed in patients with dystonia. Granger causality analysis was employed to explore the causal effects among abnormal thalamic nuclei. Support vector machines were used to test whether these abnormal features could distinguish patients with different forms of dystonia and those with dystonia from healthy controls. Compared with healthy controls, patients with blepharospasm exhibited reduced grey matter volume in the lateral geniculate and pulvinar inferior nuclei, whereas those with blepharospasm-oromandibular dystonia showed decreased grey matter volume in the ventral anterior and ventral lateral anterior nuclei. Atrophy in the pulvinar inferior nucleus in blepharospasm patients and in the ventral lateral anterior nucleus in blepharospasm-oromandibular dystonia patients was negatively correlated with clinical severity and disease duration, respectively. The proposed machine learning scheme yielded a high accuracy in distinguishing blepharospasm patients from healthy controls (accuracy: 0.89), blepharospasm-oromandibular dystonia patients from healthy controls (accuracy: 0.82) and blepharospasm from blepharospasm-oromandibular dystonia patients (accuracy: 0.94). Most importantly, Granger causality analysis revealed that a progressive driving pathway from pulvinar inferior nuclear atrophy extends to lateral geniculate nuclear atrophy and then to ventral lateral anterior nuclear atrophy with increasing clinical severity in patients with blepharospasm. These findings suggest that the pulvinar inferior nucleus in the thalamus is the focal origin of blepharospasm, extending to pulvinar inferior nuclear atrophy and subsequently extending to the ventral lateral anterior nucleus causing involuntary lower facial and masticatory movements known as blepharospasm-oromandibular dystonia. Moreover, our results also provide potential targets for neuromodulation especially deep brain stimulation in patients with blepharospasm and blepharospasm-oromandibular dystonia.
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Affiliation(s)
- Jinping Xu
- Institute of Biomedical and Health Engineering, Shenzhen Institutes of Advanced Technology, Chinese Academy of Sciences, Shenzhen 518055, China
| | - Yuhan Luo
- Department of Neurology, The First Affiliated Hospital, Sun Yat-Sen University, Guangdong Provincial Key Laboratory for Diagnosis and Treatment of Major Neurological Diseases, National Key Clinical Department and Key Discipline of Neurology, Guangzhou 510080, China
| | - Jiana Zhang
- Department of Neurology, The First Affiliated Hospital, Sun Yat-Sen University, Guangdong Provincial Key Laboratory for Diagnosis and Treatment of Major Neurological Diseases, National Key Clinical Department and Key Discipline of Neurology, Guangzhou 510080, China
| | - Linchang Zhong
- Department of Medical Imaging, Sun Yat-Sen University Cancer Center, State Key Laboratory of Oncology in Southern China, Collaborative Innovation Center for Cancer Medicine, Guangzhou 510060, China
| | - Huiming Liu
- Department of Medical Imaging, Sun Yat-Sen University Cancer Center, State Key Laboratory of Oncology in Southern China, Collaborative Innovation Center for Cancer Medicine, Guangzhou 510060, China
| | - Ai Weng
- Department of Neurology, The First Affiliated Hospital, Sun Yat-Sen University, Guangdong Provincial Key Laboratory for Diagnosis and Treatment of Major Neurological Diseases, National Key Clinical Department and Key Discipline of Neurology, Guangzhou 510080, China
| | - Zhengkun Yang
- Department of Neurology, The First Affiliated Hospital, Sun Yat-Sen University, Guangdong Provincial Key Laboratory for Diagnosis and Treatment of Major Neurological Diseases, National Key Clinical Department and Key Discipline of Neurology, Guangzhou 510080, China
| | - Yue Zhang
- Department of Neurology, The First Affiliated Hospital, Sun Yat-Sen University, Guangdong Provincial Key Laboratory for Diagnosis and Treatment of Major Neurological Diseases, National Key Clinical Department and Key Discipline of Neurology, Guangzhou 510080, China
| | - Zilin Ou
- Department of Neurology, The First Affiliated Hospital, Sun Yat-Sen University, Guangdong Provincial Key Laboratory for Diagnosis and Treatment of Major Neurological Diseases, National Key Clinical Department and Key Discipline of Neurology, Guangzhou 510080, China
| | - Zhicong Yan
- Department of Neurology, The First Affiliated Hospital, Sun Yat-Sen University, Guangdong Provincial Key Laboratory for Diagnosis and Treatment of Major Neurological Diseases, National Key Clinical Department and Key Discipline of Neurology, Guangzhou 510080, China
| | - Qinxiu Cheng
- Institute of Biomedical and Health Engineering, Shenzhen Institutes of Advanced Technology, Chinese Academy of Sciences, Shenzhen 518055, China
| | - Xinxin Fan
- Institute of Biomedical and Health Engineering, Shenzhen Institutes of Advanced Technology, Chinese Academy of Sciences, Shenzhen 518055, China
| | - Xiaodong Zhang
- Institute of Biomedical and Health Engineering, Shenzhen Institutes of Advanced Technology, Chinese Academy of Sciences, Shenzhen 518055, China
| | - Weixi Zhang
- Department of Neurology, The First Affiliated Hospital, Sun Yat-Sen University, Guangdong Provincial Key Laboratory for Diagnosis and Treatment of Major Neurological Diseases, National Key Clinical Department and Key Discipline of Neurology, Guangzhou 510080, China
| | - Qingmao Hu
- Institute of Biomedical and Health Engineering, Shenzhen Institutes of Advanced Technology, Chinese Academy of Sciences, Shenzhen 518055, China
| | - Dong Liang
- Institute of Biomedical and Health Engineering, Shenzhen Institutes of Advanced Technology, Chinese Academy of Sciences, Shenzhen 518055, China
| | - Kangqiang Peng
- Department of Medical Imaging, Sun Yat-Sen University Cancer Center, State Key Laboratory of Oncology in Southern China, Collaborative Innovation Center for Cancer Medicine, Guangzhou 510060, China
| | - Gang Liu
- Department of Neurology, The First Affiliated Hospital, Sun Yat-Sen University, Guangdong Provincial Key Laboratory for Diagnosis and Treatment of Major Neurological Diseases, National Key Clinical Department and Key Discipline of Neurology, Guangzhou 510080, China
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Duarte A, Coutinho L, Germiniani FMB, Teive HAG. Effects of onabotulinum toxin type A injections in patients with Meige's syndrome. ARQUIVOS DE NEURO-PSIQUIATRIA 2024; 82:1-7. [PMID: 38641339 PMCID: PMC11031253 DOI: 10.1055/s-0044-1785691] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/19/2023] [Accepted: 03/07/2024] [Indexed: 04/21/2024]
Abstract
BACKGROUND Meige's syndrome is a type of facial dystonia characterized by the simultaneous occurrence of blepharospasm and oromandibular dystonia. Although botulinum toxin type A (OBTA) injections are the standard treatment, evidence of their effectiveness and safety in this scenario is still lacking. OBJECTIVE Our research aimed to evaluate the improvement and occurrence of side effects following injections of onabotulinum toxin type A (OBTA) in patients with Meige's syndrome. METHODS Patients with Meige's syndrome undergoing botulinum toxin injections were enrolled in this study. We assessed dystonia intensity before and 14 days after OBTA injection using the Burke-Fahn-Marsden Dystonia Rating Scale (BFMDRS) to measure the response of symptoms in the eyes (blepharospasm) and mouth (oromandibular dystonia). Other variables, such as dosage, side effects, and demographic data, were also recorded. RESULTS The study included 41 participants, with a mean age of 67.7 years and a female-to-male ratio of 3.5:1. The mean BFMDRS score before the injections was 8.89, and after 14 days, it was 2.88. The most reported side effect was ptosis, with a 7.3% incidence. OBTA significantly reduced dystonia severity (p < 0.0001). The clinical response for the blepharospasm component was superior to the oromandibular dystonia component. CONCLUSION Our results support that OBTA seems to be an effective and safe therapeutic option for treating Meige's syndrome. The effect of OBTA was more pronounced in the treatment of blepharospasm than in oromandibular dystonia.
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Affiliation(s)
- Alexia Duarte
- Universidade Federal do Paraná, Setor de Ciências da Saúde, Curitiba PR, Brazil.
| | - Léo Coutinho
- Universidade Federal do Paraná, Programa de Pós-Graduação em Medicina Interna, Curitiba PR, Brazil.
| | | | - Hélio Afonso Ghizoni Teive
- Universidade Federal do Paraná, Setor de Ciências da Saúde, Curitiba PR, Brazil.
- Universidade Federal do Paraná, Hospital de Clínicas, Departamento de Clínica Médica, Setor de Neurologia, Curitiba PR, Brazil.
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Wu X, Xue T, Pan S, Xing W, Huang C, Zhang J, Zhao G. Pallidal versus subthalamic deep brain stimulation for Meige syndrome: A systematic review and meta-analysis. Heliyon 2024; 10:e27945. [PMID: 38510025 PMCID: PMC10950702 DOI: 10.1016/j.heliyon.2024.e27945] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/10/2023] [Revised: 03/04/2024] [Accepted: 03/08/2024] [Indexed: 03/22/2024] Open
Abstract
Background Globus pallidus internus (GPi) and subthalamic nucleus (STN) are two common deep brain stimulation (DBS) targets. This meta-analysis was to compared the efficacy and safety of these two DBS targets for the treatment of Meige syndrome (MS). Methods A systematic search was performed using EMBASE, MEDLINE, the Cochrane Library, and ClinicalTrials.gov to identify DBS trials for MS. Review Manager 5.3 was used to perform meta-analysis and the mean difference (MD) was analyzed and calculated with a random effect model. Pearson's correlation coefficients and meta-regression analyses were utilized to identify relevant predictive markers. Results Twenty trials involving 188 participants with GPi-DBS and 110 individuals with STN-DBS were eligible. Both groups showed improvement of the Burke-Fahn-Marsden Dystonia Rating Scale-Movement (BFMDRS-M) and Disability (BFMDRS-D) scores (BFMDRS-M: MD = 10.57 [7.74-13.41] for GPi-DBS, and MD = 8.59 [4.08-13.11] for STN-DBS; BFMDRS-D: MD = 5.96 [3.15-8.77] for GPi-DBS, and MD = 4.71 [1.38-8.04] for STN-DBS; all P < 0.001) from baseline to the final follow-up, while no notable disparity in improvement rates was observed between them. Stimulation-related complications occurrence was also similar between two groups (38.54 ± 24.07% vs. 43.17 ± 29.12%, P = 0.7594). Simultaneously, preoperative BFMDRS-M score and disease duration were positively connected with the relative changes in BFMDRS-M score at the final visit. Conclusion Both GPi-DBS and STN-DBS are effective MS therapies, with no differences in efficacy or the frequency of stimulation-related problems. Higher preoperative scores and longer disease duration probably predict greater improvement.
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Affiliation(s)
- Xin Wu
- Department of Neurosurgery, Suzhou Ninth People's Hospital, Suzhou, Jiangsu Province, China
| | - Tao Xue
- Department of Neurosurgery, Beijing Tiantan Hospital, Capital Medical University, Beijing, China
| | - Shiqing Pan
- A6 East in Department of Anesthesiology, The First Affiliated Hospital of Soochow University, Suzhou, Jiangsu Province, China
| | - Weikang Xing
- Department of Neurosurgery, Suzhou Ninth People's Hospital, Suzhou, Jiangsu Province, China
| | - Chuanjun Huang
- Department of Neurosurgery, Suzhou Ninth People's Hospital, Suzhou, Jiangsu Province, China
| | - Jianguo Zhang
- Department of Neurosurgery, Beijing Tiantan Hospital, Capital Medical University, Beijing, China
| | - Guozheng Zhao
- Department of Neurosurgery, Suzhou Ninth People's Hospital, Suzhou, Jiangsu Province, China
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Koptielow J, Szyłak E, Szewczyk-Roszczenko O, Roszczenko P, Kochanowicz J, Kułakowska A, Chorąży M. Genetic Update and Treatment for Dystonia. Int J Mol Sci 2024; 25:3571. [PMID: 38612382 PMCID: PMC11011602 DOI: 10.3390/ijms25073571] [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: 02/21/2024] [Revised: 03/17/2024] [Accepted: 03/21/2024] [Indexed: 04/14/2024] Open
Abstract
A neurological condition called dystonia results in abnormal, uncontrollable postures or movements because of sporadic or continuous muscular spasms. Several varieties of dystonia can impact people of all ages, leading to severe impairment and a decreased standard of living. The discovery of genes causing variations of single or mixed dystonia has improved our understanding of the disease's etiology. Genetic dystonias are linked to several genes, including pathogenic variations of VPS16, TOR1A, THAP1, GNAL, and ANO3. Diagnosis of dystonia is primarily based on clinical symptoms, which can be challenging due to overlapping symptoms with other neurological conditions, such as Parkinson's disease. This review aims to summarize recent advances in the genetic origins and management of focal dystonia.
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Affiliation(s)
- Jan Koptielow
- Department of Neurology, Medical University of Bialystok, 15-276 Bialystok, Poland; (E.S.); (J.K.); (A.K.); (M.C.)
| | - Emilia Szyłak
- Department of Neurology, Medical University of Bialystok, 15-276 Bialystok, Poland; (E.S.); (J.K.); (A.K.); (M.C.)
| | - Olga Szewczyk-Roszczenko
- Department of Synthesis and Technology of Drugs, Medical University of Bialystok, Kilinskiego 1, 15-089 Bialystok, Poland; (O.S.-R.); (P.R.)
| | - Piotr Roszczenko
- Department of Synthesis and Technology of Drugs, Medical University of Bialystok, Kilinskiego 1, 15-089 Bialystok, Poland; (O.S.-R.); (P.R.)
| | - Jan Kochanowicz
- Department of Neurology, Medical University of Bialystok, 15-276 Bialystok, Poland; (E.S.); (J.K.); (A.K.); (M.C.)
| | - Alina Kułakowska
- Department of Neurology, Medical University of Bialystok, 15-276 Bialystok, Poland; (E.S.); (J.K.); (A.K.); (M.C.)
| | - Monika Chorąży
- Department of Neurology, Medical University of Bialystok, 15-276 Bialystok, Poland; (E.S.); (J.K.); (A.K.); (M.C.)
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Zhu L, Meng H, Zhang W, Xie W, Sun H, Hou S. The pathogenesis of blepharospasm. Front Neurol 2024; 14:1336348. [PMID: 38274886 PMCID: PMC10808626 DOI: 10.3389/fneur.2023.1336348] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/13/2023] [Accepted: 12/28/2023] [Indexed: 01/27/2024] Open
Abstract
Blepharospasm is a focal dystonia characterized by involuntary tetanic contractions of the orbicularis oculi muscle, which can lead to functional blindness and loss of independent living ability in severe cases. It usually occurs in adults, with a higher incidence rate in women than in men. The etiology and pathogenesis of this disease have not been elucidated to date, but it is traditionally believed to be related to the basal ganglia. Studies have also shown that this is related to the decreased activity of inhibitory neurons in the cerebral cortex caused by environmental factors and genetic predisposition. Increasingly, studies have focused on the imbalance in the regulation of neurotransmitters, including dopamine, serotonin, and acetylcholine, in blepharospasm. The onset of the disease is insidious, and the misdiagnosis rate is high based on history and clinical manifestations. This article reviews the etiology, epidemiological features, and pathogenesis of blepharospasm, to improve understanding of the disease by neurologists and ophthalmologists.
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Affiliation(s)
- Lixia Zhu
- Department of Neurology, The First Hospital of Jilin University, Changchun, China
| | - Hongmei Meng
- Department of Neurology, The First Hospital of Jilin University, Changchun, China
| | - Wuqiong Zhang
- Department of Neurology, The First Hospital of Jilin University, Changchun, China
| | - Wenjing Xie
- Department of Neurology, The Second Hospital of Jilin University, Changchun, China
| | - Huaiyu Sun
- Department of Neurology, The First Hospital of Jilin University, Changchun, China
| | - Shuai Hou
- Department of Neurology, The First Hospital of Jilin University, Changchun, China
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Girouard E, Levy A. Meige Syndrome Following COVID Infection. Can J Neurol Sci 2023:1-2. [PMID: 37830290 DOI: 10.1017/cjn.2023.298] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/14/2023]
Affiliation(s)
- Eugénie Girouard
- Department of Neurosciences, Université de Montréal, Montreal, QC, Canada
- Department of Specialized Medicine, Neurology Service, Centre Hospitalier de l'Université de Montreal, Montreal, QC, Canada
| | - Ariel Levy
- Department of Neurosciences, Université de Montréal, Montreal, QC, Canada
- Department of Specialized Medicine, Neurology Service, Hôpital Maisonneuve-Rosemont, Montreal, QC, Canada
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Wadia PM, Mathur V, Kukkle PL, Khanna JN. Task-specific oromandibular dystonia secondary to chewing Khat (Catha edulis)- A series of 35 cases. Parkinsonism Relat Disord 2023; 114:105806. [PMID: 37619301 DOI: 10.1016/j.parkreldis.2023.105806] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/04/2023] [Revised: 08/09/2023] [Accepted: 08/13/2023] [Indexed: 08/26/2023]
Abstract
BACKGROUND The leaves of "Khat" (Catha edulis), an indigenous shrub of Yemen and Arabian Peninsula are habitually chewed by the inhabitants for psychostimulant properties. OBJECTIVE To describe a unique task specific Oro-mandibular dystonia (OMD) in Yemenese men, with a temporal association with chewing "Khat". METHODS Multicentric, retrospective analysis (2009-2020) of patients with OMD associated with "Khat" chewing, evaluating clinical features and response to Onabotulinum toxin A. RESULTS 35 Yemenese men with a negative family history, normal neuroimaging mean age of 44.31(±3.21) years and prolonged (20.31 ± 3.27 years) history of chewing Khat, around 5.16(±0.80) hours/day presented with OMD-20 jaw opening, 13 jaw closing and 2 mixed affecting chewing (n = 6), speech (n = 3), or both (n = 26). Additional lingual dystonia was seen in five. CONCLUSIONS Chewing of khat is a repetitive task involving the jaw musculature and may be one of the causative factors of this task specific OMD. Recognition can prevent disability in these regions.
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Affiliation(s)
- Pettarusp Murzban Wadia
- Movement Disorder Clinic, Department of Neurology, Jaslok Hospital and Research Centre, Mumbai, India.
| | - Vaibhav Mathur
- Movement Disorder Clinic, Department of Neurology, Jaslok Hospital and Research Centre, Mumbai, India
| | - Prashanth Lingappa Kukkle
- Center for Parkinson's Disease and Movement Disorders Clinic, Manipal Hospital, Miller's Road, Bangalore, India; Parkinson's Disease and Movement Disorders Clinic, Bangalore, India
| | - Jitendra N Khanna
- Department of Dentistry, Jaslok Hospital and Research Centre, Mumbai, India
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Yoshimura A, Hosotani Y, Kimura A, Kanda H, Okita Y, Uema Y, Gomi F. Quantitative evaluation of blinking in blepharospasm using electrooculogram-integrated smart eyeglasses. Sci Rep 2023; 13:9868. [PMID: 37332074 DOI: 10.1038/s41598-023-36094-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/31/2022] [Accepted: 05/29/2023] [Indexed: 06/20/2023] Open
Abstract
Smart eyeglasses with an integrated electrooculogram (EOG) device (JINS MEME ES_R®, JINS Inc.) were evaluated as a quantitative diagnostic tool for blepharospasm. Participants without blepharospasm (n = 21) and patients with blepharospasm (n = 19) undertook two voluntary blinking tests (light and fast) while wearing the smart eyeglasses. Vertical (Vv) and horizontal (Vh) components were extracted from time-series voltage waveforms recorded during 30 s of the blinking tests. Two parameters, the ratio between the maximum and minimum values in the power spectrum (peak-bottom ratio, Fourier transform analysis) and the mean amplitude of the EOG waveform (peak amplitude analysis) were calculated. The mean amplitude of Vh from light and fast blinking was significantly higher in the blepharospasm group than in the control group (P < 0.05 and P < 0.05). Similarly, the peak-bottom ratio of Vv from light and fast blinking was significantly lower in the blepharospasm group than in the control group (P < 0.05 and P < 0.05). The mean amplitude of Vh and peak-bottom ratio of Vv correlated with the scores determined using the Jankovic rating scale (P < 0.05 and P < 0.01). Therefore, these parameters are sufficiently accurate for objective blepharospasm classification and diagnosis.
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Affiliation(s)
- Ayano Yoshimura
- Department of Ophthalmology, Hyogo Medical University, 1-1 Mukogawa-cho, Nishinomiya, Hyogo, 663-8501, Japan
| | - Yuka Hosotani
- Department of Ophthalmology, Hyogo Medical University, 1-1 Mukogawa-cho, Nishinomiya, Hyogo, 663-8501, Japan
| | - Akiko Kimura
- Department of Ophthalmology, Hyogo Medical University, 1-1 Mukogawa-cho, Nishinomiya, Hyogo, 663-8501, Japan
| | - Hiroyuki Kanda
- Department of Ophthalmology, Hyogo Medical University, 1-1 Mukogawa-cho, Nishinomiya, Hyogo, 663-8501, Japan
| | - Youichi Okita
- Department of Ophthalmology, Hyogo Medical University, 1-1 Mukogawa-cho, Nishinomiya, Hyogo, 663-8501, Japan
| | - Yuji Uema
- Department of Ophthalmology, Hyogo Medical University, 1-1 Mukogawa-cho, Nishinomiya, Hyogo, 663-8501, Japan
| | - Fumi Gomi
- Department of Ophthalmology, Hyogo Medical University, 1-1 Mukogawa-cho, Nishinomiya, Hyogo, 663-8501, Japan.
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Liu B, Mao Z, Cui Z, Ling Z, Xu X, He K, Cui M, Feng Z, Yu X, Zhang Y. Cerebellar gray matter alterations predict deep brain stimulation outcomes in Meige syndrome. Neuroimage Clin 2023; 37:103316. [PMID: 36610311 PMCID: PMC9827385 DOI: 10.1016/j.nicl.2023.103316] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/12/2022] [Revised: 11/21/2022] [Accepted: 01/02/2023] [Indexed: 01/05/2023]
Abstract
BACKGROUND The physiopathologic mechanism of Meige syndrome (MS) has not been clarified, and neuroimaging studies centering on cerebellar changes in MS are scarce. Moreover, even though deep brain stimulation (DBS) of the subthalamic nucleus (STN) has been recognized as an effective surgical treatment for MS, there has been no reliable biomarker to predict its efficacy. OBJECTIVE To characterize the volumetric alterations of gray matter (GM) in the cerebellum in MS and to identify GM measurements related to a good STN-DBS outcome. METHODS We used voxel-based morphometry and lobule-based morphometry to compare the regional and lobular GM differences in the cerebellum between 47 MS patients and 52 normal human controls (HCs), as well as between 31 DBS responders and 10 DBS non-responders. Both volumetric analyses were achieved using the Spatially Unbiased Infratentorial Toolbox (SUIT). Further, we performed partial correlation analyses to probe the relationship between the cerebellar GM changes and clinical scores. Finally, we plotted the receiver operating characteristic (ROC) curve to select biomarkers for MS diagnosis and DBS outcomes prediction. RESULTS Compared to HCs, MS patients had GM atrophy in lobule Crus I, lobule VI, lobule VIIb, lobule VIIIa, and lobule VIIIb. Compared to DBS responders, DBS non-responders had lower GM volume in the left lobule VIIIb. Moreover, partial correlation analyses revealed a positive relationship between the GM volume of the significant regions/lobules and the symptom improvement rate after DBS surgery. ROC analyses demonstrated that the GM volume of the significant cluster in the left lobule VIIIb could not only distinguish MS patients from HCs but also predict the outcomes of STN-DBS surgery with high accuracy. CONCLUSION MS patients display bilateral GM shrinkage in the cerebellum relative to HCs. Regional GM volume of the left lobule VIIIb can be a reliable biomarker for MS diagnosis and DBS outcomes prediction.
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Affiliation(s)
- Bin Liu
- Medical School of Chinese PLA, Beijing, PR China; Department of Neurosurgery, Chinese PLA General Hospital, Beijing, PR China
| | - Zhiqi Mao
- Department of Neurosurgery, Chinese PLA General Hospital, Beijing, PR China
| | - Zhiqiang Cui
- Department of Neurosurgery, Chinese PLA General Hospital, Beijing, PR China
| | - Zhipei Ling
- Department of Neurosurgery, Chinese PLA General Hospital, Beijing, PR China
| | - Xin Xu
- Department of Neurosurgery, Chinese PLA General Hospital, Beijing, PR China
| | - Kunyu He
- Medical School of Chinese PLA, Beijing, PR China; Department of Neurosurgery, Chinese PLA General Hospital, Beijing, PR China
| | - Mengchu Cui
- Medical School of Chinese PLA, Beijing, PR China; Department of Neurosurgery, Chinese PLA General Hospital, Beijing, PR China
| | - Zhebin Feng
- Medical School of Chinese PLA, Beijing, PR China; Department of Neurosurgery, Chinese PLA General Hospital, Beijing, PR China
| | - Xinguang Yu
- Department of Neurosurgery, Chinese PLA General Hospital, Beijing, PR China; Neurosurgery Institute, Chinese PLA General Hospital, Beijing, PR China.
| | - Yanyang Zhang
- Department of Neurosurgery, Chinese PLA General Hospital, Beijing, PR China; Neurosurgery Institute, Chinese PLA General Hospital, Beijing, PR China.
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12
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Huang B, Du XD, Yao M, Lin HD, Yu WH, Zhou QH. CT-guided radiofrequency ablation of the extracranial cranial nerve for the treatment of Meige’s syndrome. Front Neurosci 2022; 16:1013555. [DOI: 10.3389/fnins.2022.1013555] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/07/2022] [Accepted: 09/20/2022] [Indexed: 11/13/2022] Open
Abstract
BackgroundMeige’ s syndrome, a rare form of dystonia, lacks effective treatment. The purpose of this study was to determine the effects of CT-guided percutaneous extracranial radiofrequency ablation of the facial and/or trigeminal nerves in the treatment of Meige’s syndrome.MethodsA total of 10 patients were enrolled in this study, with the numbers of blepharospasm dystonia syndrome (BDS), oromandibular dystonia syndrome (ODS), and blepharospasm combined with oromandibular dystonia syndrome (B-ODS) being 7, 1, and 2, respectively. BDS patients underwent radiofrequency ablation of the bilateral stylomastoid foramen facial nerve; ODS patients underwent radiofrequency ablation of the bilateral foramen oval trigeminal mandibular branch, and B-ODS patients underwent radiofrequency ablation of the bilateral stylomastoid foramen facial nerve and foramen oval trigeminal mandibular branch. The therapeutic effects and complications were observed.ResultsAll 10 patients in this series experienced improved Meige’s syndrome-related symptoms after extracranial radiofrequency ablation of the cranial and/or mandibular branches of the extracranial trigeminal nerve. Adverse events included class II–III facial paralysis and/or mandibular skin numbness. Two patients had recurrences at the 18th and 22nd months postoperatively, respectively; the other patients were being followed up.ConclusionThese results shown that CT-guided radiofrequency ablation of bilateral stylomastoid foramen facial nerve and/or oval foramen trigeminal mandibular branch can effectively treat the corresponding types of Meige’s syndrome. According to preliminary observations, the therapeutic effect may last more than 18 months.
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13
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Fan S, Liu H, Li L. The REEP family of proteins: molecular targets and role in pathophysiology. Pharmacol Res 2022; 185:106477. [PMID: 36191880 DOI: 10.1016/j.phrs.2022.106477] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/30/2022] [Revised: 09/27/2022] [Accepted: 09/28/2022] [Indexed: 11/18/2022]
Abstract
Receptor expression-enhancing proteins (REEPs) are an evolutionarily conserved protein family that is pivotal to the structure and function of the endoplasmic reticulum (ER). The REEP family can be classified into two major subfamilies in higher species, the REEP1-4 and REEP5-6 subfamilies. Within the REEP1-4 subfamily, REEP1 and REEP2 are closely related, and REEP3 and REEP4 are similarly related. The REEP family is widely distributed in various tissues. Recent studies indicate that the REEP family is involved in many pathological and physiological processes, such as ER morphogenesis and remodeling, microtubule cytoskeleton regulation, and the trafficking and expression of G protein-coupled receptors (GPCRs). Moreover, the REEP family plays crucial roles in the occurrence and development of many diseases, including neurological diseases, diabetes, retinal diseases, cardiac diseases, infertility, obesity, oligoarticular juvenile idiopathic arthritis (OJIA), COVID-19, and cancer. In the present review, we describe the distribution and structure of the REEP family. Furthermore, we summarize the functions and the associated diseases of this family. Based on the pleiotropic actions of the REEP family, the study of its family members is crucial to understanding the relevant pathophysiological processes and developing strategies to modulate and control these related diseases. AVAILABILITY OF DATA AND MATERIAL: The datasets used or analyzed during the current study are available from the corresponding author on reasonable request.
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Affiliation(s)
- Sisi Fan
- Institute of Pharmacy and Pharmacology, Hunan Provincial Key Laboratory of tumor microenvironment responsive drug research, Hunan Province Cooperative Innovation Center for Molecular Target New Drug Study, Hengyang Medical School, University of South China, Hengyang 421001, Hunan, China
| | - Huimei Liu
- Institute of Pharmacy and Pharmacology, Hunan Provincial Key Laboratory of tumor microenvironment responsive drug research, Hunan Province Cooperative Innovation Center for Molecular Target New Drug Study, Hengyang Medical School, University of South China, Hengyang 421001, Hunan, China
| | - Lanfang Li
- Institute of Pharmacy and Pharmacology, Hunan Provincial Key Laboratory of tumor microenvironment responsive drug research, Hunan Province Cooperative Innovation Center for Molecular Target New Drug Study, Hengyang Medical School, University of South China, Hengyang 421001, Hunan, China.
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14
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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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15
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Luo Y, Guo Y, Zhong L, Liu Y, Dang C, Wang Y, Zeng J, Zhang W, Peng K, Liu G. Abnormal dynamic brain activity and functional connectivity of primary motor cortex in blepharospasm. Eur J Neurol 2021; 29:1035-1043. [PMID: 34962021 DOI: 10.1111/ene.15233] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/08/2021] [Revised: 11/19/2021] [Accepted: 12/17/2021] [Indexed: 11/29/2022]
Abstract
BACKGROUND Accumulating evidence indicates that dynamic amplitude of low-frequency fluctuations (dALFF) or functional connectivity (dFC) can provide complementary information, distinct from static ALFF (sALFF) or FC (sFC), in detecting brain functional abnormalities in brain diseases. We aimed to examine whether dALFF and dFC can offer valuable information for the detection of functional brain abnormalities in patients with blepharospasm. METHODS We collected resting-state functional magnetic resonance imaging data from 46 patients each of blepharospasm, hemifacial spasm (HFS), and healthy controls (HCs). We examined inter-group differences in sALFF and dALFF to investigate abnormal regional brain activity in patients with blepharospasm. Based on the dALFF results, we conducted seed-based sFC and dFC analyses to identify static and dynamic connectivity changes in brain networks centered on areas showing abnormal temporal variability of local brain activity in patients with blepharospasm. RESULTS Compared with HCs, patients with blepharospasm displayed different brain functional change patterns characterized by increased sALFF in the left primary motor cortex (PMC) but increased dALFF variance in the right PMC. However, differences were not found between patients with HFS and HCs. Additionally, patients with blepharospasm exhibited decreased dFC strength, but no change in sFC, between right PMC and ipsilateral cerebellum compared with HCs; these findings were replicated when patients with blepharospasm were compared to those with HFS. CONCLUSIONS Our findings highlight that dALFF and dFC are complementary to sALFF and sFC and can provide valuable information for detecting brain functional abnormalities in blepharospasm. Blepharospasm may be a network disorder involving the cortico-ponto-cerebello-thalamo-cortical circuit.
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Affiliation(s)
- Yuhan Luo
- Department of Neurology, The First Affiliated Hospital, Sun Yat-Sen University, Guangdong Provincial Key Laboratory for Diagnosis and Treatment of Major Neurological Diseases, National Key Clinical, Department and Key Discipline of Neurology, No. 58, Zhongshan Road 2, Guangzhou, China
| | - Yaomin Guo
- Department of Neurology, The First Affiliated Hospital, Sun Yat-Sen University, Guangdong Provincial Key Laboratory for Diagnosis and Treatment of Major Neurological Diseases, National Key Clinical, Department and Key Discipline of Neurology, No. 58, Zhongshan Road 2, Guangzhou, China
| | - Linchang Zhong
- Department of Medical Imaging, Sun Yat-Sen University Cancer Center, State Key Laboratory of Oncology in Southern China, Collaborative Innovation Center for Cancer Medicine, Guangzhou, China
| | - Ying Liu
- Department of Neurology, The First Affiliated Hospital, Sun Yat-Sen University, Guangdong Provincial Key Laboratory for Diagnosis and Treatment of Major Neurological Diseases, National Key Clinical, Department and Key Discipline of Neurology, No. 58, Zhongshan Road 2, Guangzhou, China
| | - Chao Dang
- Department of Neurology, The First Affiliated Hospital, Sun Yat-Sen University, Guangdong Provincial Key Laboratory for Diagnosis and Treatment of Major Neurological Diseases, National Key Clinical, Department and Key Discipline of Neurology, No. 58, Zhongshan Road 2, Guangzhou, China
| | - Ying Wang
- Department of Neurology, The First Affiliated Hospital, Sun Yat-Sen University, Guangdong Provincial Key Laboratory for Diagnosis and Treatment of Major Neurological Diseases, National Key Clinical, Department and Key Discipline of Neurology, No. 58, Zhongshan Road 2, Guangzhou, China
| | - Jinsheng Zeng
- Department of Neurology, The First Affiliated Hospital, Sun Yat-Sen University, Guangdong Provincial Key Laboratory for Diagnosis and Treatment of Major Neurological Diseases, National Key Clinical, Department and Key Discipline of Neurology, No. 58, Zhongshan Road 2, Guangzhou, China
| | - Weixi Zhang
- Department of Neurology, The First Affiliated Hospital, Sun Yat-Sen University, Guangdong Provincial Key Laboratory for Diagnosis and Treatment of Major Neurological Diseases, National Key Clinical, Department and Key Discipline of Neurology, No. 58, Zhongshan Road 2, Guangzhou, China
| | - Kangqiang Peng
- Department of Medical Imaging, Sun Yat-Sen University Cancer Center, State Key Laboratory of Oncology in Southern China, Collaborative Innovation Center for Cancer Medicine, Guangzhou, China
| | - Gang Liu
- Department of Neurology, The First Affiliated Hospital, Sun Yat-Sen University, Guangdong Provincial Key Laboratory for Diagnosis and Treatment of Major Neurological Diseases, National Key Clinical, Department and Key Discipline of Neurology, No. 58, Zhongshan Road 2, Guangzhou, China.,Guangdong-HongKong, Greater Bay Area Center for Brain Science and Brain-Inspired Intelligence, Guangzhou, China
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16
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Manzo N, Ginatempo F, Belvisi D, Defazio G, Conte A, Deriu F, Berardelli A. Pathophysiological mechanisms of oromandibular dystonia. Clin Neurophysiol 2021; 134:73-80. [PMID: 34979293 DOI: 10.1016/j.clinph.2021.11.075] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/28/2021] [Revised: 11/03/2021] [Accepted: 11/28/2021] [Indexed: 11/03/2022]
Abstract
Oromandibular dystonia (OMD) is a rare form of focal idiopathic dystonia. OMD was clinically identified at the beginning of the 20th century, and the main clinical features have been progressively described over the years. However, OMD has several peculiarities that still remain unexplained, including the high rate of oral trauma, which is often related to the onset of motor symptoms. The purpose of this paper was to formulate a hypothesis regarding the pathophysiology of OMD, starting from the neuroanatomical basis of the masticatory and facial systems and highlighting the features that differentiate this condition from other forms of focal idiopathic dystonia. We provide a brief review of the clinical and etiological features of OMD as well as neurophysiological and neuroimaging findings obtained from studies in patients with OMD. We discuss possible pathophysiological mechanisms underlying OMD and suggest that abnormalities in sensory input processing may play a prominent role in OMD pathophysiology, possibly triggering a cascade of events that results in sensorimotor cortex network dysfunction. Finally, we identify open questions that future studies should address, including the effect of abnormal sensory input processing and oral trauma on the peculiar neurophysiological abnormalities observed in OMD.
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Affiliation(s)
| | | | - Daniele Belvisi
- IRCCS NEUROMED, Via Atinense, 18, 86077 Pozzilli, IS, Italy; Department of Human Neurosciences, Sapienza, University of Rome, Viale Dell' Università 30, 00185 Rome, Italy
| | - Giovanni Defazio
- Movement Disorders Center, Department of Neurology, University of Cagliari, SS 554 km 4.500, 09042 Cagliari, Italy
| | - Antonella Conte
- IRCCS NEUROMED, Via Atinense, 18, 86077 Pozzilli, IS, Italy; Department of Human Neurosciences, Sapienza, University of Rome, Viale Dell' Università 30, 00185 Rome, Italy
| | - Franca Deriu
- Department of Biomedical Sciences, University of Sassari, Viale S. Pietro, 43c, 07100 Sassari, Italy; Unit of Endocrinology, Nutritional and Metabolic Disorders, AOU Sassari, 07100 Sassari, Italy
| | - Alfredo Berardelli
- IRCCS NEUROMED, Via Atinense, 18, 86077 Pozzilli, IS, Italy; Department of Human Neurosciences, Sapienza, University of Rome, Viale Dell' Università 30, 00185 Rome, Italy.
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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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