Management Challenges in Oromandibular Dystonia: The Role of Botulinum Toxin-A

Background: Oromandibular dystonia is a focal or segmental cranio-cervical dystonia, with diverse incapacitating clinical manifestations. Though botulinum toxin injection has emerged as an effective symptomatic treatment; yet, many unanswered questions are not addressed by the current available studies. Objective: To evaluate the efficacy of Botulinum toxin type A (BTX-A) treatment in patients with oromandibular dystonia. Methods: This prospective study included 13 patients with refractory oromandibular dystonia, who were followed up for 3 months. All patients were videotaped according to Dystonia Study Group Videotape examination protocol before and after injections. Injection technique was based on clinical observation coupled with electromyography. Primary outcome measure was the global impression scale (GIS), and secondary outcome measure was quantified according to Unified Dystonia Rating Scale (UDRS). Results: Patients showed improvement of both primary and secondary efficacy measures, maximum satisfactory responses were detected at the 4 week after injection. This improvement was maintained till the end of the study visits (12 week), and we could not detect any adverse events. Conclusion: BTX-A is considered an effective and safe treatment option for refractory OMD. [Egypt J Neurol Psychiat Neurosurg. 2010; 47(3): 347-354]