Identification and treatment of cervical and oromandibular dystonia in acutely brain-injured patients

Steven E. Lo, Axel J. Rosengart, Roberta L. Novakovic, Jung Kang Un, Darshan N. Shah, Mohsin A. Khan, Arif Dalvi, Fernando D. Goldenberg, R. Loch Macdonald, Jeffrey I. Frank

Research output: Contribution to journalArticle

12 Citations (Scopus)

Abstract

Introduction: 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.

Original languageEnglish (US)
Pages (from-to)139-145
Number of pages7
JournalNeurocritical Care
Volume3
Issue number2
DOIs
StatePublished - Oct 2005

Fingerprint

Torticollis
Botulinum Toxins
Brain
Dystonia
Brain Injuries
Therapeutics
Status Epilepticus
Cerebral Hemorrhage
Movement Disorders
Stroke
Safety

Keywords

  • Botulinum toxin
  • Brain injury
  • Cervical dystonia
  • Intracerebral hemorrhage
  • Oromandibular dystonia

ASJC Scopus subject areas

  • Clinical Neurology
  • Critical Care and Intensive Care Medicine

Cite this

Identification and treatment of cervical and oromandibular dystonia in acutely brain-injured patients. / Lo, Steven E.; Rosengart, Axel J.; Novakovic, Roberta L.; Un, Jung Kang; Shah, Darshan N.; Khan, Mohsin A.; Dalvi, Arif; Goldenberg, Fernando D.; Macdonald, R. Loch; Frank, Jeffrey I.

In: Neurocritical Care, Vol. 3, No. 2, 10.2005, p. 139-145.

Research output: Contribution to journalArticle

Lo, SE, Rosengart, AJ, Novakovic, RL, Un, JK, Shah, DN, Khan, MA, Dalvi, A, Goldenberg, FD, Macdonald, RL & Frank, JI 2005, 'Identification and treatment of cervical and oromandibular dystonia in acutely brain-injured patients', Neurocritical Care, vol. 3, no. 2, pp. 139-145. https://doi.org/10.1385/NCC:3:2:139
Lo, Steven E. ; Rosengart, Axel J. ; Novakovic, Roberta L. ; Un, Jung Kang ; Shah, Darshan N. ; Khan, Mohsin A. ; Dalvi, Arif ; Goldenberg, Fernando D. ; Macdonald, R. Loch ; Frank, Jeffrey I. / Identification and treatment of cervical and oromandibular dystonia in acutely brain-injured patients. In: Neurocritical Care. 2005 ; Vol. 3, No. 2. pp. 139-145.
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AU - Rosengart, Axel J.

AU - Novakovic, Roberta L.

AU - Un, Jung Kang

AU - Shah, Darshan N.

AU - Khan, Mohsin A.

AU - Dalvi, Arif

AU - Goldenberg, Fernando D.

AU - Macdonald, R. Loch

AU - Frank, Jeffrey I.

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N2 - Introduction: 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.

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