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Yoshida K, Bakke M. Therapeutic Uses and Efficacy of Botulinum Toxin in Orofacial Medicine: A Dental Perspective. Toxins (Basel) 2024; 16:220. [PMID: 38787072 PMCID: PMC11126014 DOI: 10.3390/toxins16050220] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/28/2024] [Accepted: 04/26/2024] [Indexed: 05/25/2024] Open
Abstract
Botulinum neurotoxin (BoNT) is the exotoxin of Clostridium botulinum, a Gram-positive, spore-forming bacterium [...].
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Affiliation(s)
- Kazuya Yoshida
- Department of Oral and Maxillofacial Surgery, National Hospital Organization, Kyoto Medical Center, 1-1 Mukaihata-cho, Fukakusa, Fushimi-ku, Kyoto 612-8555, Japan
| | - Merete Bakke
- Clinical Oral Physiology, Department of Odontology, Faculty of Health and Medical Sciences, University of Copenhagen, DK-2200 Copenhagen, Denmark
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2
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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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3
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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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4
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Younce JR, Cascella RH, Berman BD, Jinnah HA, Bellows S, Feuerstein J, Wagle Shukla A, Mahajan A, Chang FCF, Duque KR, Reich S, Richardson SP, Deik A, Stover N, Luna JM, Norris SA. Anatomical categorization of isolated non-focal dystonia: novel and existing patterns using a data-driven approach. DYSTONIA 2023; 2:11305. [PMID: 37920445 PMCID: PMC10621194 DOI: 10.3389/dyst.2023.11305] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Indexed: 11/04/2023]
Abstract
According to expert consensus, dystonia can be classified as focal, segmental, multifocal, and generalized, based on the affected body distribution. To provide an empirical and data-driven approach to categorizing these distributions, we used a data-driven clustering approach to compare frequency and co-occurrence rates of non-focal dystonia in pre-defined body regions using the Dystonia Coalition (DC) dataset. We analyzed 1,618 participants with isolated non-focal dystonia from the DC database. The analytic approach included construction of frequency tables, variable-wise analysis using hierarchical clustering and independent component analysis (ICA), and case-wise consensus hierarchical clustering to describe associations and clusters for dystonia affecting any combination of eighteen pre-defined body regions. Variable-wise hierarchical clustering demonstrated closest relationships between bilateral upper legs (distance = 0.40), upper and lower face (distance = 0.45), bilateral hands (distance = 0.53), and bilateral feet (distance = 0.53). ICA demonstrated clear grouping for the a) bilateral hands, b) neck, and c) upper and lower face. Case-wise consensus hierarchical clustering at k = 9 identified 3 major clusters. Major clusters consisted primarily of a) cervical dystonia with nearby regions, b) bilateral hand dystonia, and c) cranial dystonia. Our data-driven approach in a large dataset of isolated non-focal dystonia reinforces common segmental patterns in cranial and cervical regions. We observed unexpectedly strong associations between bilateral upper or lower limbs, which suggests that symmetric multifocal patterns may represent a previously underrecognized dystonia subtype.
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Affiliation(s)
- J. R. Younce
- Department of Neurology and Biomedical Research Imaging Center, University of North Carolina at Chapel Hill, Chapel Hill, NC, United States
| | - R. H. Cascella
- School of Medicine, Washington University, St. Louis, MO, United States
| | - B. D. Berman
- Department of Neurology, Virginia Commonwealth University, Richmond, VA, United States
| | - H. A. Jinnah
- Department of Neurology, Emory University, Atlanta, GA, United States
- Department of Human Genetics, Emory University, Atlanta, GA, United States
| | - S Bellows
- Department of Neurology, Baylor College of Medicine, Houston, TX, United States
| | - J. Feuerstein
- Department of Neurology, University of Colorado Anschutz Medical Campus, Aurora, CO, United States
| | - A. Wagle Shukla
- Department of Neurology, University of Florida, Gainesville, FL, United States
| | - A. Mahajan
- Rush Parkinson’s Disease and Movement Disorders Program, Rush University Medical Center, Chicago, IL, United States
| | - F. C. F. Chang
- Movement Disorders Unit, Neurology Department, Westmead Hospital & Sydney Medical School, University of Sydney, Sydney, NSW, Australia
| | - K. R. Duque
- James J. and Joan A. Gardner Family Center for Parkinson’s Disease and Movement Disorders, Department of Neurology, University of Cincinnati, Cincinnati, OH, United States
| | - S. Reich
- Department of Neurology, University of Maryland, Baltimore, MD, United States
| | - S. Pirio Richardson
- Department of Neurology, University of New Mexico and New Mexico VA Healthcare System, Albuquerque, NM, United States
| | - A. Deik
- Parkinson Disease and Movement Disorders Center, Department of Neurology, University of Pennsylvania, Philadelphia, PA, United States
| | - N. Stover
- Department of Neurology, Heersink School of Medicine, The University of Alabama at Birmingham, Birmingham, AL, United States
| | - J. M. Luna
- Department of Radiology, School of Medicine, Washington University, St. Louis, MO, United States
| | - S. A. Norris
- Department of Radiology, School of Medicine, Washington University, St. Louis, MO, United States
- Department of Neurology, School of Medicine, Washington University, St. Louis, MO, United States
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5
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Das G, Li S, Tunio RA, Jamali RH, Ullah I, Fernando KWTM. The implementation of green supply chain management (GSCM) and environmental management system (EMS) practices and its impact on market competitiveness during COVID-19. ENVIRONMENTAL SCIENCE AND POLLUTION RESEARCH INTERNATIONAL 2023; 30:68387-68402. [PMID: 37121948 PMCID: PMC10149637 DOI: 10.1007/s11356-023-27077-z] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 02/25/2023] [Accepted: 04/13/2023] [Indexed: 05/04/2023]
Abstract
Despite great academic interest in global green supply chain management (GSCM) practices, its effectiveness for environmental management systems (EMS) and market competitiveness during COVID-19 remains untapped. Existing literature suggests that a fundamental link between GSCM, EMS, and market competitiveness is missing, as supply management is critical to maintain market competitiveness. To fill this gap in the literature, this study examines whether environmental management systems influence the link between GSCM practice and market competitiveness in China. We also propose the articulating role of big data analytics and artificial intelligence (BDA-AI) and environmental visibility toward these associations in the context of the COVID-19 pandemic. We evaluated the proposed model using regression-based structural equation modeling (SEM) with primary data (n = 330). This result provides empirical evidence of the impact of GSCM on EMS and market competitiveness. Moreover, the results show that the BDA-AI and the environmental visibility enhanced the positive relationship between GSCM-EMS and EMS and market competitiveness in China. Recent research shows that supply chain professionals, policymakers, managers, and researchers are turning to formal EMS, BDA-AI, and environmental visibility to help their organizations achieve the competitiveness that the market indicates they need.
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Affiliation(s)
- Ghansham Das
- Business School, Sichuan University, Yihuan Road, Chengdu, 610065 People’s Republic of China
| | - Shan Li
- Business School, Sichuan University, Yihuan Road, Chengdu, 610065 People’s Republic of China
| | - Raza Ali Tunio
- College of Management, Sichuan Agricultural University, 211 Huimin Road, Chengdu, 611130 People’s Republic of China
| | - Riaz Hussain Jamali
- School of Economics, Sichuan University, Yihuan Road, Chengdu, 610065 People’s Republic of China
| | - Ihsan Ullah
- College of International Relations, Sichuan University, Yihuan Road, Chengdu, 610065 People’s Republic of China
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Jinnah HA, DeFazio G. Adult-onset focal dystonias: To lump or split. INTERNATIONAL REVIEW OF NEUROBIOLOGY 2023; 169:317-327. [PMID: 37482396 DOI: 10.1016/bs.irn.2023.04.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 07/25/2023]
Abstract
The adult-onset focal dystonias are a group of clinically heterogeneous disorders that affect different regions of the body. Although they affect different regions with different clinical manifestations, there is evidence that etiopathogenesis is shared at the anatomical, physiological, and genetic levels. However, there is also evidence that etiopathogenesis varies. This chapter summarizes the evidence for lumping or splitting these apparently different clinical phenotypes. It also includes some potential explanations to explain the similarities and differences.
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Affiliation(s)
- H A Jinnah
- Departments of Neurology, Human Genetics, and Pediatrics, Atlanta, GA, United States.
| | - Giovanni DeFazio
- Department of Medical Sciences and Public Health, University of Cagliari, Cagliari, Italy
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7
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Baizabal-Carvallo JF, Alonso-Juarez M, Jankovic J. Oromandibular tics associated with Tourette syndrome. J Neurol 2023; 270:2591-2596. [PMID: 36723683 DOI: 10.1007/s00415-023-11583-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/08/2023] [Revised: 01/18/2023] [Accepted: 01/19/2023] [Indexed: 02/02/2023]
Abstract
BACKGROUND Tourette syndrome (TS) is the most common cause of chronic tics. Patients with TS frequently manifest motor tics involving the eyes and face but oromandibular (OM) tics have been rarely studied. MATERIALS AND METHODS We reviewed the medical records and video-recordings of 155 consecutive patients with TS in our movement disorders clinic. In addition, we studied 35 patients with classic tardive dyskinesia (TD) and compared their clinical and demographic features with those with TS. RESULTS We identified 41 patients with OM tics (26.5%). Although patients with OM tics had a greater overall tic severity and higher frequency of.complex motor and phonic tics, in the bivariate analysis, only comorbid dystonic tics (P = 0.001), greater number of affected body parts (P = 0.012) and more frequent eye-rolling tics (P = 0.059) were included in the final regression model after controlling for other variables. When compared with patients with OM tics, patients with classic TD had more frequently masticatory movements (sensitivity, 0.86; specificity, 0.95), continuous tongue movements (sensitivity, 0.71; specificity, 1.0) and continuous OM movements (sensitivity, 0.4; specificity, 1.0). CONCLUSIONS OM tics are common and often troublesome or even disabling symptoms in patients with TS. They may be difficult to differentiate from TD, but the latter is typically manifested by continuous orolingual and masticatory movements.
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Affiliation(s)
- José Fidel Baizabal-Carvallo
- Parkinson's Disease Center and Movement Disorders Clinic, Department of Neurology, Baylor College of Medicine, Houston, TX, USA. .,Department of Sciences and Engineering, University of Guanajuato, Ave León 428, Jardines del Moral, 37320, León, Guanajuato, Mexico.
| | | | - Joseph Jankovic
- Parkinson's Disease Center and Movement Disorders Clinic, Department of Neurology, Baylor College of Medicine, Houston, TX, USA
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8
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Safarpour D, Jabbari B. Botulinum toxin for motor disorders. HANDBOOK OF CLINICAL NEUROLOGY 2023; 196:539-555. [PMID: 37620089 DOI: 10.1016/b978-0-323-98817-9.00003-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 08/26/2023]
Abstract
Botulinum neurotoxins are a group of biological toxins produced by the gram-negative bacteria Clostridium botulinum. After intramuscular injection, they produce dose-related muscle relaxation, which has proven useful in the treatment of a large number of motor and movement disorders. In this chapter, we discuss the utility of botulinum toxin treatment in three major and common medical conditions related to the dysfunction of the motor system, namely dystonia, tremor, and spasticity. A summary of the existing literature is provided along with different techniques of injection including those recommended by the authors.
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Affiliation(s)
- Delaram Safarpour
- Department of Neurology, Oregon Health & Science University, Portland, OR, United States
| | - Bahman Jabbari
- Department of Neurology, Yale University School of Medicine, New Haven, CT, United States.
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9
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Neurophysiological Basis of Deep Brain Stimulation and Botulinum Neurotoxin Injection for Treating Oromandibular Dystonia. Toxins (Basel) 2022; 14:toxins14110751. [PMID: 36356002 PMCID: PMC9694803 DOI: 10.3390/toxins14110751] [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: 10/10/2022] [Revised: 10/29/2022] [Accepted: 11/01/2022] [Indexed: 11/06/2022] Open
Abstract
Oromandibular dystonia (OMD) induces severe motor impairments, such as masticatory disturbances, dysphagia, and dysarthria, resulting in a serious decline in quality of life. Non-invasive brain-imaging techniques such as electroencephalography (EEG) and magnetoencephalography (MEG) are powerful approaches that can elucidate human cortical activity with high temporal resolution. Previous studies with EEG and MEG have revealed that movements in the stomatognathic system are regulated by the bilateral central cortex. Recently, in addition to the standard therapy of botulinum neurotoxin (BoNT) injection into the affected muscles, bilateral deep brain stimulation (DBS) has been applied for the treatment of OMD. However, some patients' OMD symptoms do not improve sufficiently after DBS, and they require additional BoNT therapy. In this review, we provide an overview of the unique central spatiotemporal processing mechanisms in these regions in the bilateral cortex using EEG and MEG, as they relate to the sensorimotor functions of the stomatognathic system. Increased knowledge regarding the neurophysiological underpinnings of the stomatognathic system will improve our understanding of OMD and other movement disorders, as well as aid the development of potential novel approaches such as combination treatment with BoNT injection and DBS or non-invasive cortical current stimulation therapies.
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Yoshida K. Effects of Botulinum Toxin Therapy on Health-Related Quality of Life Evaluated by the Oromandibular Dystonia Rating Scale. Toxins (Basel) 2022; 14:656. [PMID: 36287925 PMCID: PMC9609031 DOI: 10.3390/toxins14100656] [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: 08/27/2022] [Revised: 09/14/2022] [Accepted: 09/20/2022] [Indexed: 12/02/2022] Open
Abstract
Oromandibular dystonia (OMD) refers to a focal dystonia in the stomatognathic system. Health-related quality of life (HRQoL) in isolated dystonia is associated with non-motor symptoms such as depression, anxiety, and pain, as well as motor symptoms. To evaluate HRQoL in patients with OMD, the therapeutic effects of botulinum neurotoxin (BoNT) therapy were assessed using a recently developed and validated comprehensive measurement tool called the Oromandibular Dystonia Rating Scale (OMDRS). Altogether, 408 patients (jaw closing dystonia, n = 223; tongue (lingual) dystonia, n = 86; jaw opening dystonia, n = 50; jaw deviation dystonia, n = 23; jaw protrusion dystonia, n = 13; and lip (labial) dystonia, n = 13) were evaluated at baseline and after the end of BoNT therapy or in a stable status. The total OMDRS score reduced significantly from 149.1 to 57.6 (p < 0.001). Mean improvement was 63.1%. All examiner-rated subscales (severity, disability, and pain) and patient-rated questionnaire scores (general, eating, speech, cosmetic, social/family life, sleep, annoyance, mood, and psychosocial function) were significantly lower at the endpoint than at baseline (p < 0.001). The BoNT injection had a highly positive impact on patient HRQoL, and the OMDRS could evaluate both motor phenomena and non-motor symptoms.
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Affiliation(s)
- Kazuya Yoshida
- Department of Oral and Maxillofacial Surgery, National Hospital Organization, Kyoto Medical Center 1-1 Mukaihata-cho, Fukakusa, Fushimi-ku, Kyoto 612-8555, Japan
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11
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Kilic-Berkmen G, Defazio G, Hallett M, Berardelli A, Ferrazzano G, Belvisi D, Klein C, Bäumer T, Weissbach A, Perlmutter JS, Feuerstein J, Jinnah HA. Diagnosis and classification of blepharospasm: Recommendations based on empirical evidence. J Neurol Sci 2022; 439:120319. [PMID: 35716653 PMCID: PMC9357089 DOI: 10.1016/j.jns.2022.120319] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/21/2022] [Revised: 05/18/2022] [Accepted: 06/06/2022] [Indexed: 11/22/2022]
Abstract
BACKGROUND Blepharospasm is one of the most common subtypes of dystonia, and often spreads to other body regions. Despite published guidelines, the approach to diagnosis and classification of affected body regions varies among clinicians. OBJECTIVE To delineate the clinical features used by movement disorder specialists in the diagnosis and classification of blepharospasm according to body regions affected, and to develop recommendations for a more consistent approach. METHODS Cross-sectional data for subjects diagnosed with all types of isolated dystonia were acquired from the Dystonia Coalition, an international, multicenter collaborative research network. Data were evaluated to determine how examinations recorded by movement disorder specialists were used to classify blepharospasm as focal, segmental, or multifocal. RESULTS Among all 3222 participants with isolated dystonia, 210 (6.5%) had a diagnosis of focal blepharospasm. Among these 210 participants, 34 (16.2%) had dystonia outside of upper face region. Factors such as dystonia severity across different body regions and number of body regions affected influenced the classification of blepharospasm as focal, segmental, or multifocal. CONCLUSIONS Although focal blepharospasm is the second most common type of dystonia, a high percentage of individuals given this diagnosis had dystonia outside of the eye/upper face region. These findings are not consistent with existing guidelines for the diagnosis and classification of focal blepharospasm, and point to the need for more specific guidelines for more consistent application of existing recommendations for diagnosis and classification.
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Affiliation(s)
- Gamze Kilic-Berkmen
- Department of Neurology, Emory University School of Medicine, Atlanta, GA, USA
| | - Giovanni Defazio
- Department of Medical Sciences and Public Health, University of Cagliari, Cagliari, Italy
| | - Mark Hallett
- Human Motor Control Section, National Institute of Neurological Disorders and Stroke, National Institute of Health, Bethesda, MD, USA
| | - Alfredo Berardelli
- Department of Human Neuroscience, Sapienza University of Rome, Viale dell'Università 30, 00185 Rome, Italy; IRCCS NEUROMED, Via Atinense 18, 86077 Pozzilli, Italy
| | - Gina Ferrazzano
- Department of Human Neuroscience, Sapienza University of Rome, Viale dell'Università 30, 00185 Rome, Italy
| | - Daniele Belvisi
- Department of Human Neuroscience, Sapienza University of Rome, Viale dell'Università 30, 00185 Rome, Italy; IRCCS NEUROMED, Via Atinense 18, 86077 Pozzilli, Italy
| | - Christine Klein
- Institute of Neurogenetics and Department of Neurology, University of Luebeck, University Hospital of Schleswig-Holstein, Campus Luebeck, Luebeck, Germany
| | - Tobias Bäumer
- Institute of System Motor Science, University of Lübeck, Ratzeburger Allee 160, Lübeck, Germany
| | - Anne Weissbach
- Institute of Neurogenetics and Department of Neurology, University of Luebeck, University Hospital of Schleswig-Holstein, Campus Luebeck, Luebeck, Germany; Institute of System Motor Science, University of Lübeck, Ratzeburger Allee 160, Lübeck, Germany
| | - Joel S Perlmutter
- Department of Neurology, Radiology, Neuroscience, Physical Therapy and Occupational Therapy, Washington University School of Medicine, St Louis, MO, USA
| | | | - H A Jinnah
- Department of Neurology, Emory University School of Medicine, Atlanta, GA, USA; Department of Human Genetics, Emory University School of Medicine, Atlanta, GA, USA.
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12
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Gandhi SE, Anderson DG, Newman EJ. A Clinical Approach to Focal Dystonias. ADVANCES IN CLINICAL NEUROSCIENCE & REHABILITATION 2022. [DOI: 10.47795/ufdf2068] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022] Open
Abstract
Dystonia is a hyperkinetic movement disorder (HMD), characterised by sustained or intermittent involuntary muscle contractions resulting in abnormal postures and/or movements [1]. Although primary dystonia has an estimated prevalence of 16 per 100,000 [2], the diagnosis may be delayed, due to its clinical heterogeneity, the lack of objective biomarkers and the potential for pseudodystonic conditions to mimic it [1,3]. We provide an overview of the classification and common subtypes of focal dystonia, focusing on the clinical phenomenology and diagnosis.
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13
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Bologna M, Valls-Solè J, Kamble N, Pal PK, Conte A, Guerra A, Belvisi D, Berardelli A. Dystonia, chorea, hemiballismus and other dyskinesias. Clin Neurophysiol 2022; 140:110-125. [PMID: 35785630 DOI: 10.1016/j.clinph.2022.05.014] [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: 03/01/2022] [Revised: 05/12/2022] [Accepted: 05/24/2022] [Indexed: 11/30/2022]
Abstract
Hyperkinesias are heterogeneous involuntary movements that significantly differ in terms of clinical and semeiological manifestations, including rhythm, regularity, speed, duration, and other factors that determine their appearance or suppression. Hyperkinesias are due to complex, variable, and largely undefined pathophysiological mechanisms that may involve different brain areas. In this chapter, we specifically focus on dystonia, chorea and hemiballismus, and other dyskinesias, specifically, levodopa-induced, tardive, and cranial dyskinesia. We address the role of neurophysiological studies aimed at explaining the pathophysiology of these conditions. We mainly refer to human studies using surface and invasive in-depth recordings, as well as spinal, brainstem, and transcortical reflexology and non-invasive brain stimulation techniques. We discuss the extent to which the neurophysiological abnormalities observed in hyperkinesias may be explained by pathophysiological models. We highlight the most relevant issues that deserve future research efforts. The potential role of neurophysiological assessment in the clinical context of hyperkinesia is also discussed.
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Affiliation(s)
- Matteo Bologna
- Department of Human Neurosciences, Sapienza University of Rome, Italy; IRCCS Neuromed, Pozzilli (IS), Italy
| | - Josep Valls-Solè
- Institut d'Investigació Biomèdica August Pi I Sunyer, Villarroel, 170, Barcelona, Spain
| | - Nitish Kamble
- Department of Neurology, National Institute of Mental Health & Neurosciences (NIMHANS), Bengaluru, India
| | - Pramod Kumar Pal
- Department of Neurology, National Institute of Mental Health & Neurosciences (NIMHANS), Bengaluru, India
| | - Antonella Conte
- Department of Human Neurosciences, Sapienza University of Rome, Italy; IRCCS Neuromed, Pozzilli (IS), Italy
| | | | - Daniele Belvisi
- Department of Human Neurosciences, Sapienza University of Rome, Italy; IRCCS Neuromed, Pozzilli (IS), Italy
| | - Alfredo Berardelli
- Department of Human Neurosciences, Sapienza University of Rome, Italy; IRCCS Neuromed, Pozzilli (IS), Italy.
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Yoshida K. Botulinum Toxin Therapy for Oromandibular Dystonia and Other Movement Disorders in the Stomatognathic System. Toxins (Basel) 2022; 14:282. [PMID: 35448891 PMCID: PMC9026473 DOI: 10.3390/toxins14040282] [Citation(s) in RCA: 11] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/07/2022] [Revised: 04/01/2022] [Accepted: 04/11/2022] [Indexed: 01/02/2023] Open
Abstract
Various movement disorders, such as oromandibular dystonia, oral dyskinesia, bruxism, functional (psychogenic) movement disorder, and tremors, exist in the stomatognathic system. Most patients experiencing involuntary movements due to these disorders visit dentists or oral surgeons, who may be the first healthcare providers. However, differential diagnoses require neurological and dental knowledge. This study aimed to review scientific advances in botulinum toxin therapy for these conditions. The results indicated that botulinum toxin injection is effective and safe, with few side effects in most cases when properly administered by an experienced clinician. The diagnosis and treatment of movement disorders in the stomatognathic system require both neurological and dental or oral surgical knowledge and skills, and well-designed multicenter trials with a multidisciplinary team approach must be necessary to ensure accurate diagnosis and proper treatment.
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Affiliation(s)
- Kazuya Yoshida
- Department of Oral and Maxillofacial Surgery, National Hospital Organization, Kyoto Medical Center, 1-1 Mukaihata-cho, Fukakusa, Fushimi-ku, Kyoto 612-8555, Japan
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15
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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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