Identification and treatment of cervical and oromandibular dystonia in acutely brain-injured patients.
BACKGROUND
Primary cervical and oromandibular dystonia (CD and OMD, respectively) are well-recognized movement disorders, often treated with botulinum toxin (BTx). In contrast, dystonia related to acute brain injuries is not well delineated. Our objective was to define in neurocritically ill patients the clinical characteristics of CD and OMD and to investigate the safety of BTx.


METHODS
All acutely brain-injured patients admitted to a neurocritical care unit over a 10-month period were prospectively screened for CD and OMD. Clinical characteristics, etiology of brain injury, and pattern of dystonia were analyzed. Patients with clinically significant CD and OMD were treated with BTx and followed for 12 weeks.


RESULTS
Of 165 patients screened, 33 had new-onset CD or OMD. Of 21 patients enrolled, 14 had CD, 5 had OMD, and 2 had both. The pattern of brain injury included 13 cerebral hemorrhages, 6 ischemic strokes, 1 status epilepticus, and 1 unclear etiology. Improvement after BTx was seen in four of seven patients with CD and two of four with OMD; no adverse effects occurred. Spontaneous improvement was recorded in 7 of 11 nontreated patients with CD or OMD.


CONCLUSIONS
Acute secondary CD or OMD, associated with a variety of causes, was identified in 20% of acutely brain-injured patients. The temporal profile of dystonia onset and resolution in these patients was variable. Treatment with BTx in the neurocritical care setting seems to be safe. Future, larger scale randomized studies should evaluate the effectiveness of BTx treatment in this patient population.
Lo
Steven E
SE
Department of Neurology, Neurocritical Care and Acute Stroke Program, The University of Chicago and Pritzker School of Medicine, Chicago, IL 60637, USA.
Rosengart
Axel J
AJ
Novakovic
Roberta L
RL
Kang
Un Jung
UJ
Shah
Darshan N
DN
Khan
Mohsin A
MA
Dalvi
Arif
A
Goldenberg
Fernando D
FD
Macdonald
R Loch
RL
Frank
Jeffrey I
JI
D000328:Adult; D018726:Anti-Dyskinesia Agents / Q000627:therapeutic use*; D001905:Botulinum Toxins / Q000627:therapeutic use*; D001930:Brain Injuries / Q000150:complications / Q000503:physiopathology*; D002675:Child, Preschool; D003422:Critical Care; D020821:Dystonic Disorders / Q000175:diagnosis* / Q000453:epidemiology / Q000628:therapy; D005260:Female; D006801:Humans; D008297:Male; D008336:Mandibular Diseases / Q000175:diagnosis / Q000188:drug therapy / Q000453:epidemiology / Q000628:therapy; D008875:Middle Aged; D009059:Mouth Diseases / Q000175:diagnosis / Q000188:drug therapy / Q000453:epidemiology / Q000628:therapy; D011187:Posture; D014103:Torticollis / Q000175:diagnosis* / Q000188:drug therapy / Q000453:epidemiology / Q000628:therapy; D016896:Treatment Outcome
D018726:Anti-Dyskinesia Agents; D001905:Botulinum Toxins