Abstract
Objective: To review experience of Botulinum Toxin (BoNT) injections for Oromandibular Dystonia (OMD).
Background: OMD causes sustained or repetitive, forceful contractions of the muscles involving jaw and tongue causing jaw opening, jaw closing, lingual and mixed dystonias. When oral pharmacologic agents are inadequate, BoNT is standard of care.
Design/Methods: A single center, retrospective chart review (July 2013 – June 2018) of BoNT injections for OMD. Wastage was defined as leftover drug from the vial; prepared but not injected. Patient not receiving injections within last 6 months was considered a ‘dropout’.
Results: We had 43 patients (21 females), median age 58 years (range 21–88) with 231 encounters (avg. 5.4/patient, range 1–16). Most commonly used toxin was OnabotulinumToxinA (OnaBoNT, 88%), and very few patients with IncobotulinumToxinA (IncoBoNT, n=3) and RimabotulinumToxinB (RimaBoNT, n=2). Jaw closing dystonia was more common (70%, 60% females) then jaw-opening (21%) and lingual dystonia (21%) with overlap. Isolated Lingual dystonia injections were rare (11%), commonly associated with jaw opening (56%); while Jaw opening injections were never solitary. Isolated Jaw closing injections were also uncommon (23%) and frequently associated with cervical (40%) and facial (40%) injections.
Average total dose (in Units, with range) of OnaBoNT was 66 (10–180) for Jaw closing; 54 (30–100) for Jaw opening and 16 (5–30) for Lingual dystonia. RimaBoNT (1000–2000) and IncoBoNT (45–50) were only used for Jaw closing dystonia. Average wastage of Botox was 25 units/patient. Dropout rate over 5 years was 37% after average 4 sessions (range 1–11). Most common reason was lost to follow up (22%) and deceased (22%), while lack of benefits (17%) and side effects (dysphagia 17% and weakness 11%) were uncommon reasons.
Conclusions: In our series, jaw-closing dystonia was the most frequent and most OMD were segmental in nature. Although side effects and lack of benefit are infrequently reported, dropout was common.
Disclosure: Dr. Ameer has nothing to disclose. Dr. Syed has nothing to disclose. Dr. Bertoni has received personal compensation for consulting, serving on a scientific advisory board, speaking, or other activities with KYOWA. Dr. Hellman has received personal compensation for consulting, serving on a scientific advisory board, speaking, or other activities with Teva Pharmaceuticals. Dr. Torres-Russotto has nothing to disclose. Dr. Bhatti has received personal compensation for consulting, serving on a scientific advisory board, speaking, or other activities with Abbvie, Accadia, Merz, Allergan Pakistan, Medtronic, Adamas and Teva Neurosciences.
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