Science topic

Dystonia - Science topic

An attitude or posture due to the co-contraction of agonists and antagonist muscles in one region of the body. It most often affects the large axial muscles of the trunk and limb girdles. Conditions which feature persistent or recurrent episodes of dystonia as a primary manifestation of disease are referred to as DYSTONIC DISORDERS. (Adams et al., Principles of Neurology, 6th ed, p77)
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In Japan Botox is not officially approved to oromandibular dystonia (jaw closing dystonia, jaw opening dystonia, jaw protrusion dystonia, jaw deviation dystonia, and lingual dystonia). I would like to know in which countries Botox has been approved to oromandibular dystonia.
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I was informed that Botox is approved in the following 100 countries. However, I do not know what indications are available in each country. If you know, I would appreciate it if you could tell me.
Argentina, Aruba, Australia, Austria, Azerbaijan, Bahrain, Bangladesh, Barbados, Belgium, Bolivia, Brazil, Brunei, Bulgaria, Canada, Cayman islands, Chile, China, Colombia, Costa Rica, Croatia, Curacao, Cyprus, Czech republic, Denmark, Dominican republic, Ecuador, Egypt, El Salvador, Estonia, Finland, France, Georgia, Germany, Greece, Guatemala, Honduras, Hong Kong, Hungary, Iceland, India, Indonesia, Ireland, Israel, Italy, Jamaica, Japan, Jordan, Kenya, Korea, Kuwait, Latvia, Lebanon, Lithuania, Luxembourg, Macao, Malaysia, Malta, Mauritius, Mexico, Morocco, Namibia, Nepal, Netherlands, New Zealand, Nicaragua, Norway, Oman, Pakistan, Palestinian territory, Panama, Peru, Philippines, Poland, Portugal, Qatar, Romania, Russia, Saudi Arabia, Serbia, Singapore, Slovak republic, Slovenia, South Africa, Spain, Sri Lanka, St. Maarten, Sweden, Switzerland, Taiwan, Thailand, Trinidad and Tobago, Tunisia, Turkey, Ukraine, United Arab emirates, United Kingdom, United States, Uruguay, Venezuela, Vietnam
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Are there any hospitals that are working on a multidisciplinary team approach for involuntary movements in the orofacial region such as oromandibular dystonia?
I mean, the multidisciplinary team approach is a collaboration between medical specialists (neurologists, neurosurgeons, psychiatrists, otolaryngologists) and dental specialists (dentists, oral surgeons, prosthodontists) for diagnosis and treatment.
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Dear Dr. Bhogaraju Anand,
Thank you very much for your valuable information. Unfortunately, it is unclear whether dental specialists participate in the diagnosis and treatment of movement disorders as a multidisciplinary team approach.
Vast majority of the literatures on oromandibular dystonia is published mainly by medical specialists such as neurologists. Although I think a collaboration between medical and dental specialists must be necessary for diagnosis and treatment, there are very few reports of collaboration with dental professionals.
Best regards,
Kazuya Yoshida
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When and who made the first report on oromandibular dystonia?
I think the following literature is the first, but does anyone know any other literature?
Romberg M.H. Krampf im Muskelgebiete der Pars minor Quinti. Masticatorischer Gesichtskrampf. Trismus. In: Lehrbuch der Nervenkaranheiten des Menschen, Alexander Duncker, Berlin, 308-316. 1846.
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Dear Vaibhav Mathur, excellent answer.
Marsden CD. Blepharospasm-oromandibular dystonia syndrome (Brueghel's syndrome). A variant of adult-onset torsion dystonia? J Neurol Neurosurg Psychiatry. 1976 Dec;39(12):1204-9. doi: 10.1136/jnnp.39.12.1204. PMID: 1011031; PMCID: PMC492566.
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Oromandibular dystonia following antiemetic administration seen gradually and the dystonic attack caused the head to move towards left side repeatedly in a 12yrs boy having hepatitis A. The condition was managed by paediatrician via medication. But I am searching for physical therapy intervention in this case!
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Hi,
Physical therapy modality including speech therapy, oral sensory devices and biofeedback, and so forth also have a positive role.
Speech therapists can offer training and communication aids to patients with oromandibular or laryngeal dystonia, and they can help in preventing complications in patients with transient dysphagia resulting from botulinum toxin injections.
All the best,
Mehmet
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I use TMS to evaluate the cortical excitability of subjects with different movement disorders. Recently, I have started acquiring recordings from patients who have rest tremor or dystonia of hand (from FDI muscle). In many cases, the surface EMG recordings are not silent. Should I classify these recording as RMT or AMT? Is there any technique to ensure RMT is measured despite muscle activity?
Thanks in advance!!
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Veja as amplitudes dos sinais obtidos e veja qual o valor em Mv e com isso você pode adicionar mais dois cursores horizontais fixo a uma amplitude que você considera o que é sinal e o que é evento espontâneo. Me diz o sistema que voçê usa para avaliação, marcas da TMS e do eletromiografia.
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In addition to my own experience with patients having torsion dystonia, I have come across mention of two patients whose ambulation forward was quite impacted, while walking in reverse was absolutely normal.Are there any other disorders where this has been observed?
Bill Jankel
Grand Canyon University
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Thats the problem. I believe they are still alive. They had been treated with
Parsidol and Tegretal for the co-contractions so I am trying to reverse engineer starting with the diagnosis and then looking at a possible stereochemical clue to indicate the possible network and structures involved and how they could induce the co-contraction state. I'm tracking down a copy of the Pathology of the midbrain reticular system and a copy of the Cerebellum in movement.
I started in the era of "Foringer" boards and multi-pole switches to run lab equipment, and wonder if if similar, multi-stimuli, or multi inhibitory activation may also be a clue. I already have sleep EEG's on these patients as well as applied behavioral analysis for a number of behaviors. But the gait disruption, in only one direction, seems to be a lead that should be followed. Thank you for your response.
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Wide range of dosages of botulinum toxin are used to partially paralyze arm muscles varying from patient to patient in indications arm spasticity, dystonia, tremor etc. Injection guidance and dose recommendations are established for specific indications (e.g. spasticity) backed by evidence from clinical studies. In other indications (e.g. essential, dystonic or parkinson tremor) no such evidence based guidances exist. Treatment approaches are therefore diverse (booster injections, fixed dosages to specified muscles, costumization of muscles and dosages based on visual or technical measurement of tremor severity and type). Still injection technique and injector´s skills play a significant role in maximizing the effect and minimizing side effects of appied dosages. Current rate of therapy discontinuation is reported over 20% after first injections session in tremor (due to several reasons e.g. lack of efficacy, side effects) whereby the starting dose was quite low and increased by follow-up visits to titrate the ideal dose. Muscle volume and physical activity level characteristics of patients additionally complicate the therapeutic decision (e.g. a subject with large muscle muss due to body building would require higher dosages than a patient with average daily activities and "normal muscle mass"). If minimum doses needed for full paralysis of individual muscles in a patient could be modelled by an algorithm based on evidence, it could ease dosing decision. Combined with the knowledge of functional reduction targeted by the dosing scheme could be individualized and efficacy of treatment could be maximized by applying only one injection session. Thereby the tolerability could also be optimized providing lower failure rates after first attempt.
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Please share me the best answer might you get...
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In Japan, oromandibular dystonia is often misdiagnosed as temporomandibular disorders, bruxism, or psychogenic disorder. Most cases diagnosed by dentists or oral surgeons have been treated with dental appliances or unnecessary surgery. Delay in an accurate diagnosis and appropriate treatment has resulted in aggravation of oromandibular dystonia.
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Hi, Dr. Kazuya Yoshida , I believe that the question your asking is very hard to narrow down. Mostly, because there is not much literature discussing all oromandibular movements variants from a clinically-oriented standpoint. I, a colleague, and a very known Chilean movement disorders neurologist just uploaded a chapter of our authorship discussing the subject in detail from a clinically based perspective. We would like to invite you to read our chapter and give us your input. My best
Dr. Skármeta
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Can you recommend references?
Any suggestions for comparing EPS liability for D2/D3 antagonists that are pGP substrates?
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Well, after an exhaustive lit. search and much discussion. We settled on the mouse amphetamine/catalepsy model for assessing CNS binding and the use of CaCo II cells to look at BBB permeability related to PgP.
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Despite dyskenisias, day-time sleepiness...
might also speech impairment occur or loss of concentration?
is there any evidence of significant differences between ingesting liquid and solid levodopa?
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I am aware of the following issues: 
Fluctuations in efficacy of L-dopa; chorea; hallucination and certain neuroendocrine side effects (e.g., renewed sexual interests in some individuals).
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Relationship of arm dystonia with handedness in CBD.
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Yes. In my experience it is so. But data from literature are not clear. 
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Camptocormia in PD
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Hi Abdul! This is still an issue in the literature. Some patients may have dystonia of the abdominal muscles but this is a minor mechanism, according to new data. Myopathy of extensor muscles is a major mechanism, but stil we don't know what causes this myopathy. Recently, it was pointed out how patients with camptocormia have more frequently vertebral diseases or ostheoporosis, but we don't know yet if this is the consequence of abnormal postures or a precipitanting factor. 
A new review on the topis is this:
Srivanitchapoom P, Hallett M
Camptocormia in Parkinson's disease: definition, epidemiology, pathogenesis and treatment modalities.
J Neurol Neurosurg Psychiatry. 2016 Jan;87(1):75-85. doi: 10.1136/jnnp-2014-310049. Epub 2015 Apr 20.
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The efficacy of botulinum toxin injection in treatment of jaw -closing oromandibular dystonia is well documented in the literature. However, patients with jaw- opening dystonia have little or inferior benefits from botulinum toxin injection .
Is there a scientific evidence to explain, why jaw-opening dystonia patients havenot respond as patients with jaw-closing dystonia? 
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I don't know if a scientific evidence exist, but I think that benefit depends on injection site and possible adverse events.
Treatment of submentalis muscle complex, including anterior digastric belly muscle, could increase swallowing disorders, limiting the treatment effectiveness. So, lateral pterygoid is actually often the only muscle treated, and it is not so easy to inject. Intra-oral way seems to be the best one.
On the other side, it seems that patient's feeling improve more when jaw-closing dystonia is treated, with the return of an oral feeding.
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Both are motor disorders causing orofacial abnormal movement . Are there any differences in pathogenesis , diagnosis and treatments ?
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Dystonia is often a component movement disorder in Dyskinesia.
For example in Levodopa induced Dyskinesia in Parkinson's disease or in Huntingdon's Dyskinesia, the principal components are dystonia and chorea.
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some reliable data would be awesome and / or names of experts in that field I can get in contact with, thanks in advance
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early 40s is a bit late for DRD, but can happen. In this cases you would need to exclude early onset PD (especially Parkin) that can present with isolated lower-limb dystonia. 
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I am providing physical therapy treatment in addition to Botox injection for a patient with Idiopathic Spasmodic Torticollis. I would like to know any valid method to determine the cervical lateral tilt and axial rotation..
This patient presents with combination of right cervical lateral tilt with left rotation.
I find difficult to measure it. since, it is not isolated movement.
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You can use 2D Kinematic Software "Kinovea", available free at www.kinovea.org .
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Especially treatment options and teams.
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We are looking for DRD patients (www.segawa.de). Do you know patients with high doses of levodopa?
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Dear Mark,
thank you very much for this information,
Yes, indeed, a great man.
regards
Wolfgang
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Extra pyramidal reactions produced by metoclopramide and prochlorperazine? Is there any evidence of severe EPS in patients using Metachlorpromide in comparison to Prochlorprazine?
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Dear Shahid Qayoom,
Bateman et al. are here on RG and are the best to answer your question:
_metoclopramide_and_prochlorperazine
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I'm doing a small study for my thesis about the use of kinesiotape in the rehabilitation of clients suffering from spasmodic torticollis, and I don't find any evidencebased studies or researches about the topic. Does anyone of you have some experience to share?
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Hi Sandra, interesting, can you tell us a little more about your experience with these patients? They are a complex disorder with various histories and causes one of them being severe neurological problems. Which group were you looking at and/or treating?
These are the studies I know of on taping the trapezius:
1. Aiguada R et al (2013) Effets du bandage neurmuscularie (kinesiotaping) sur le tonus du trapezius superieur. Kinesitherapie La Revue vol 13.issue 134,Febr.2013 pages 58-59
2. Billis Evdokia et al (2009)Does taping affect the upper and lower trapezius electromyographic activity amongst patients with suspected subacromial impingement? A pilot study. J.ofspo.sci & med 2009 suppl 11, 1-198
3. Tsun Shun Huang et al (2012) Relationship between trapezius muscle activity and typing speed; taping effect. Eronomics vol. 55 issue 11,pg 1404-1411
Pelosin's study is the only one I know of on focal dystonia and taping.
In chapter 16 of Rehabilitation in Movement Disorders 2013 authors Iansek & Morris kinesiotape is mentioned once as a possible treatment option.
Study on the effect of tape on 'cramps' in another area is:
Effects of Kinesio Taping on venous symptoms, bioelectrical activity of gastrocnemius muscle, range of ankle motion and quality of life in post-menopausal women with chronic venous insufficiency: a randomized controlled trial. María Encarnación Aguilar-Ferrándiz et al
Looking forward to hearing from you Esther