1
|
Trinchillo A, Esposito M, Terranova C, Rizzo V, Fabbrini G, Ferrazzano G, Belvisi D, Erro R, Barone P, Bono F, Di Biasio F, Bentivoglio AR, Lettieri C, Altavista MC, Scaglione CLM, Albanese A, Mascia MM, Muroni A, Pisani A, Berardelli A, Defazio G. Oromandibular dystonia: from onset to spread a multicenter italian study. Neurol Sci 2024; 45:4341-4348. [PMID: 38536550 DOI: 10.1007/s10072-024-07488-7] [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: 11/07/2023] [Accepted: 03/19/2024] [Indexed: 08/09/2024]
Abstract
BACKGROUND Detailed information about the epidemiological and phenomenological differences among the aetiological subtypes of oromandibular dystonia (OMD) is lacking. Moreover, the OMD tendency to spread to other body sites has never been investigated. AIM To compare the main demographic and clinical features of OMD in different aetiological groups and assess the risk of spread. MATERIALS AND METHODS We retrospectively analysed data from patients contained in the Italian Dystonia Registry. The risk of spread was assessed by Kaplan Meyer curves and Cox regression analysis. RESULTS The study included 273 patients (175 women) aged 55.7 years (SD 12.7) at OMD onset. Female predominance was observed. Idiopathic dystonia was diagnosed in 241 patients, acquired dystonia in 22. In 50/273 patients, dystonia started in the oromandibular region (focal OMD onset); in 96/273 patients the onset involved the oromandibular region and a neighbouring body site (segmental/multifocal OMD onset); and in 127/273 patients OMD was a site of spread from another body region. Sensory trick (ST) and positive family history predominated in the idiopathic group. No dystonia spread was detected in the acquired group, whereas spread mostly occurred within the first five years of history in 34% of the focal OMD onset idiopathic patients. Cox regression analysis revealed ST as a significant predictor of spread (HR, 12.1; 95% CI, 2.5 - 18.8; P = 0.002). CONCLUSION This large study provides novel information about the clinical phenomenology of idiopathic and acquired OMD. We pointed out a possible role of oestrogens in favouring dystonia development. Moreover, we described for the first time the association between ST and dystonia spread, revealing possible common pathophysiological mechanisms. Our findings may be suggested as a referral point for future pathophysiological and therapeutic studies on OMD.
Collapse
Affiliation(s)
- Assunta Trinchillo
- Department of Neurosciences, Reproductive Sciences and Odontostomatology, "Federico II" University, Naples, Italy.
| | | | - Carmen Terranova
- Department of Clinical and Experimental Medicine, University of Messina, Messina, Italy
| | - Vincenzo Rizzo
- Department of Clinical and Experimental Medicine, University of Messina, Messina, Italy
| | - Giovanni Fabbrini
- Department of Human Neurosciences, Sapienza University of Roma, Rome, Italy
| | - Gina Ferrazzano
- Department of Human Neurosciences, Sapienza University of Roma, Rome, Italy
| | - Daniele Belvisi
- Department of Human Neurosciences, Sapienza University of Roma, Rome, Italy
| | - Roberto Erro
- Department of Medicine, Surgery and Dentistry "Scuola Medica Salernitana" University of Salerno, Baronissi, SA, Italy
| | - Paolo Barone
- Department of Medicine, Surgery and Dentistry "Scuola Medica Salernitana" University of Salerno, Baronissi, SA, Italy
| | - Francesco Bono
- Academic Hospital - A.O.U. "R. Dulbecco", Catanzaro, Italy
| | | | - Anna Rita Bentivoglio
- Clinical Neurology Unit - Movement Disorders, University of Rome "Università Cattolica del Sacro Cuore", Hospital of Rome "Agostino Gemelli", Rome, Italy
| | - Christian Lettieri
- Clinical Neurology Unit "S. Maria Della Misericordia" University, Hospital of Udine, Udine, Italy
| | | | | | - Alberto Albanese
- Clinical Institute, Department of Neurology, "Humanitas", Milan, Italy
| | | | - Antonella Muroni
- Neurology Unit, University Hospital of Cagliari, Cagliari, Italy
| | - Antonio Pisani
- Department of Brain and Behavioral Sciences, University of Pavia, Pavia, Italy
- IRCCS Mondino Foundation, Pavia, Italy
| | - Alfredo Berardelli
- Department of Human Neurosciences, Sapienza University of Roma, Rome, Italy
| | - Giovanni Defazio
- Department of Translational Biomedicine and Neuroscience, University of Bari, Bari, Italy
| |
Collapse
|
2
|
Oliveira D, Moura D, Azevedo S, Guimarães B, Toste S. Oromandibular Dystonia as a Side Effect of Methotrexate. Cureus 2023; 15:e47248. [PMID: 38022297 PMCID: PMC10656108 DOI: 10.7759/cureus.47248] [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: 10/18/2023] [Indexed: 12/01/2023] Open
Abstract
Oromandibular dystonia is a focal dystonia characterized by involuntary movements of the jaw, oropharynx, lips, and tongue. The diagnosis of oromandibular dystonia is clinical and can be complex. For effective treatment, it is essential to understand its underlying etiology. A 70-year-old man was referred to our center with a diagnosis of Meige's syndrome, which had been present for five and a half years, for receiving botulinum toxin-A (BoNT-A) injections. Upon physical examination, he exhibited oromandibular dystonia, with a score of 177 points on the Oromandibular Dystonia Rating Scale (OMDRS). He had a history of taking methotrexate for six years, as he was diagnosed with psoriatic arthritis during that time. The possibility of methotrexate-induced dystonia was considered. A switch from methotrexate to sulfasalazine was initiated. Subsequently, the patient showed progressive improvement in his symptoms, as reflected by an OMDRS score of 103 points. After eight weeks, the medical team decided to supplement the treatment with BoNT-A injections, resulting in an OMDRS score of 75. While there is currently no definitive evidence linking the use of methotrexate to the development of dystonia, it is advisable to consider oromandibular dystonia as a potential side effect of methotrexate until more robust evidence becomes available.
Collapse
Affiliation(s)
- Diana Oliveira
- Physical Medicine and Rehabilitation, Centro Hospitalar de Entre Douro e Vouga, Santa Maria da Feira, PRT
| | - David Moura
- Physical Medicine and Rehabilitation, Centro Hospitalar de Entre Douro e Vouga, Santa Maria da Feira, PRT
| | - Sofia Azevedo
- Physical Medicine and Rehabilitation, Centro Hospitalar de Entre Douro e Vouga, Santa Maria da Feira, PRT
| | - Bruno Guimarães
- Physical Medicine and Rehabilitation, Centro Hospitalar de Entre Douro e Vouga, Santa Maria da Feira, PRT
| | - Sofia Toste
- Physical Medicine and Rehabilitation, Centro Hospitalar de Entre Douro e Vouga, Santa Maria da Feira, PRT
| |
Collapse
|
3
|
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.
Collapse
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.
| |
Collapse
|
4
|
Romano M, Bagnato S, Altavista MC, Avanzino L, Belvisi D, Bologna M, Bono F, Carecchio M, Castagna A, Ceravolo R, Conte A, Cosentino G, Eleopra R, Ercoli T, Esposito M, Fabbrini G, Ferrazzano G, Lalli S, Mascia MM, Osio M, Pellicciari R, Petrucci S, Valente EM, Valentino F, Zappia M, Zibetti M, Girlanda P, Tinazzi M, Defazio G, Berardelli A. Diagnostic and therapeutic recommendations in adult dystonia: a joint document by the Italian Society of Neurology, the Italian Academy for the Study of Parkinson’s Disease and Movement Disorders, and the Italian Network on Botulinum Toxin. Neurol Sci 2022; 43:6929-6945. [DOI: 10.1007/s10072-022-06424-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/16/2022] [Accepted: 09/21/2022] [Indexed: 11/07/2022]
|
5
|
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.
Collapse
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
| |
Collapse
|
6
|
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.
Collapse
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
| |
Collapse
|
7
|
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.
Collapse
|