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)
Questions related to Dystonia
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.
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.
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.
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!
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!!
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?
Grand Canyon University
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.
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.
Can you recommend references?
Any suggestions for comparing EPS liability for D2/D3 antagonists that are pGP substrates?
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?
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?
Both are motor disorders causing orofacial abnormal movement . Are there any differences in pathogenesis , diagnosis and treatments ?
some reliable data would be awesome and / or names of experts in that field I can get in contact with, thanks in advance
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.
Extra pyramidal reactions produced by metoclopramide and prochlorperazine? Is there any evidence of severe EPS in patients using Metachlorpromide in comparison to Prochlorprazine?
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?