|LETTER TO THE EDITOR
|Year : 2019 | Volume
| Issue : 6 | Page : 554-555
Oromandibular dystonia and botulinum neurotoxin: An overview
Jamir Pitton Rissardo1, Ana Letícia Fornari Caprara2
1 Department of Neurology, Federal University of Santa Maria, Santa Maria, Brazil
2 Department of Medicine, Federal University of Santa Maria, Santa Maria, Brazil
|Date of Web Publication||17-Oct-2019|
Jamir Pitton Rissardo
Department of Neurology, Federal University of Santa Maria, Santa Maria
Source of Support: None, Conflict of Interest: None
|How to cite this article:|
Rissardo JP, Fornari Caprara AL. Oromandibular dystonia and botulinum neurotoxin: An overview. Med J DY Patil Vidyapeeth 2019;12:554-5
We read an article on “Medical Journal of Dr. D.Y. Patil University” with great interest. Shailaja et al. reported two cases of oromandibular dystonia (OMD) who were initially misdiagnosed, but later responded well to appropriate therapy. The first patient was diagnosed with dissociative motor disorder, and the other was without a clear diagnosis along a period of almost 2 years.
Albanese et al. in 2013 defined dystonia as a movement disorder with sustained or intermittent muscle contractions causing abnormal, often repetitive, movements, postures, or both. In this context, OMD is a type of focal dystonia involving the mouth, jaw, and tongue causing involuntary jaw closure or opening, deviation of the jaw, facial grimacing, and tongue movements.
We would like to address two recent systematic reviews with botulinum toxin (BoNT) in the management of OMD, which we think that together with the study of Shailaja et al. could lead to a better understanding of the treatment of this disorder.
The study of Comella in 2018 concluded that the use of BoNT is not yet established and the studies available are single small controlled. She explained that the lack of large controlled studies could preclude any conclusion on the efficacy and safety of this medication. However, the available data suggest that BoNT may be the most effective treatment available and the more important medication to improve quality of life.
In 2019, Dadgardoust et al. made a systematic review with meta-analysis. Their results showed that BoNT is efficacious in OMD by reducing dystonic movements and is generally considered a safe injection. Furthermore, they stated that their results with OMD are congruent with the BoNT for the previous data with focal dystonia.
Based on these two reviews and other reports, we made a table with the type of OMD, injection site, recommended doses of BoNT, and possible adverse effects [Table 1]. We found some interesting characteristics in these reviews. First, Dadgardoust et al. found positive results, but the majority of the studies analyzed are single small controlled study, open-label observational studies, or retrospective chart reviews. Second, the majority of adverse effects reported with BoNT in OMD are related to formulation. We assumed that probably the continued improvements in the BoNT formulations and techniques lead to the markable decrease in the percentages of adverse effects from 62.2% to 2.38%. Third, we believe that both the rarity and the complexity of this movement disorder could influence in the previous data.,,
|Table 1: Type of oromandibular dystonia, injection site, recommended doses of botulinum toxin, and possible adverse effects|
Click here to view
In summary, the case reported by Shailaja et al. puts in evidence important discussions about the OMD such as the socially embarrassing, misdiagnosis, and multiple consultations with different physicians. Therefore, case reports like this are essential for the awareness of rare diseases, mainly among general practitioners.
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Conflicts of interest
There are no conflicts of interest.
| References|| |
Shailaja B, Chaudhury S, Rohatgi S, Saldanha D. Oromandibular dystonia: A rare clinical entity. Med J Dr. DY Patil Vidyapeeth 2019 1;12:370.
Albanese A, Bhatia K, Bressman SB, Delong MR, Fahn S, Fung VS, et al.
Phenomenology and classification of dystonia: A consensus update. Mov Disord 2013;28:863-73.
Comella CL. Systematic review of botulinum toxin treatment for oromandibular dystonia. Toxicon 2018;147:96-9.
Dadgardoust PD, Rosales RL, Asuncion RM, Dressler D. Botulinum neurotoxin a therapy efficacy and safety for oromandibular dystonia: A meta-analysis. J Neural Transm (Vienna) 2019;126:141-8.
Jankovic J. An update on new and unique uses of botulinum toxin in movement disorders. Toxicon 2018;147:84-8.