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Journal of Neurology, Neurosurgery, and Psychiatry logoLink to Journal of Neurology, Neurosurgery, and Psychiatry
. 2000 Feb;68(2):186–190. doi: 10.1136/jnnp.68.2.186

Tardive and idiopathic oromandibular dystonia: a clinical comparison

E Tan 1, J Jankovic 1
PMCID: PMC1736782  PMID: 10644785

Abstract

OBJECTIVE—Most patients with tardive dystonia have a focal onset involving the cranial-cervical region. Because of its resemblance to idiopathic cranial dystonia, a common form of dystonia, it often poses a diagnostic problem. To compare clinical features and response to botulinum toxin (BTX) injections between patients with tardive and idiopathic oromandibular dystonia (OMD).
METHODS—Patients seen in a movement disorder clinic who satisfied the inclusion criteria for tardive or idiopathic OMD were studied. The clinical variables and responses to BTX between the two groups of patients were compared. In the tardive group, we also compared the clinical variables between those with oro-facial-lingual stereotypies, and those without.
RESULTS—Twenty four patients with tardive OMD and 92 with idiopathic OMD were studied. There were no differences in the demographic characteristics. Most were women, with duration of symptoms longer than 8 years. The mean duration of neuroleptic exposure was 7.1(SD 7.9) years. Jaw closure was the most frequent subtype of OMD (tardive=41.7%, idiopathic=51.1%). Idiopathic patients were more likely to have coexistent cervical dystonia (p<0.05), whereas isolated OMD was significantly higher in tardive patients (p<0.05). Limb stereotypies, akathisia, and respiratory dyskinesia were seen only in the tardive OMD. Frequency of oro-facial-lingual stereotypy was significantly higher in the tardive than the idiopathic group (75.0% v 31.5%, p<0.0001). The peak effect of BTX was similar in both groups.
CONCLUSIONS—Oro-facial-lingual stereotypies were significantly more frequent in the tardive than the idiopathic group. Presence of stereotypic movements in the limbs, akathisia, and respiratory dyskinesias in patients with OMD strongly suggests prior neuroleptic exposure. Dystonia in tardive OMD is more likely to be restricted to the oromandibular region, whereas in patients with idiopathic OMD, there is often coexistent cervical dystonia. BTX is equally effective in both groups of patients.



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Selected References

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  1. Andreassen O. A., Finsen B., Ostergaard K., Sørensen J. C., West M. J., Jørgensen H. A. The relationship between oral dyskinesias produced by long-term haloperidol treatment, the density of striatal preproenkephalin messenger RNA and enkephalin peptide, and the number of striatal neurons expressing preproenkephalin messenger RNA in rats. Neuroscience. 1999 Jan;88(1):27–35. doi: 10.1016/s0306-4522(98)00175-4. [DOI] [PubMed] [Google Scholar]
  2. Burke R. E., Fahn S., Jankovic J., Marsden C. D., Lang A. E., Gollomp S., Ilson J. Tardive dystonia: late-onset and persistent dystonia caused by antipsychotic drugs. Neurology. 1982 Dec;32(12):1335–1346. doi: 10.1212/wnl.32.12.1335. [DOI] [PubMed] [Google Scholar]
  3. Burke R. E., Kang U. J. Tardive dystonia: clinical aspects and treatment. Adv Neurol. 1988;49:199–210. [PubMed] [Google Scholar]
  4. Campbell M., Locascio J. J., Choroco M. C., Spencer E. K., Malone R. P., Kafantaris V., Overall J. E. Stereotypies and tardive dyskinesia: abnormal movements in autistic children. Psychopharmacol Bull. 1990;26(2):260–266. [PubMed] [Google Scholar]
  5. Casey D. E. Tardive dyskinesia and atypical antipsychotic drugs. Schizophr Res. 1999 Mar 1;35 (Suppl):S61–S66. doi: 10.1016/s0920-9964(98)00160-1. [DOI] [PubMed] [Google Scholar]
  6. Defazio G., Lamberti P., Lepore V., Livrea P., Ferrari E. Facial dystonia: clinical features, prognosis and pharmacology in 31 patients. Ital J Neurol Sci. 1989 Dec;10(6):553–560. doi: 10.1007/BF02333790. [DOI] [PubMed] [Google Scholar]
  7. Dura J. R., Mulick J. A., Rasnake L. K. Prevalence of stereotypy among institutionalized nonambulatory profoundly mentally retarded people. Am J Ment Defic. 1987 Mar;91(5):548–549. [PubMed] [Google Scholar]
  8. Friedman J. H., Kucharski L. T., Wagner R. L. Tardive dystonia in a psychiatric hospital. J Neurol Neurosurg Psychiatry. 1987 Jun;50(6):801–803. doi: 10.1136/jnnp.50.6.801. [DOI] [PMC free article] [PubMed] [Google Scholar]
  9. Greene P., Shale H., Fahn S. Analysis of open-label trials in torsion dystonia using high dosages of anticholinergics and other drugs. Mov Disord. 1988;3(1):46–60. doi: 10.1002/mds.870030107. [DOI] [PubMed] [Google Scholar]
  10. Hardie R. J., Lees A. J. Neuroleptic-induced Parkinson's syndrome: clinical features and results of treatment with levodopa. J Neurol Neurosurg Psychiatry. 1988 Jun;51(6):850–854. doi: 10.1136/jnnp.51.6.850. [DOI] [PMC free article] [PubMed] [Google Scholar]
  11. Jankovic J., Beach J. Long-term effects of tetrabenazine in hyperkinetic movement disorders. Neurology. 1997 Feb;48(2):358–362. doi: 10.1212/wnl.48.2.358. [DOI] [PubMed] [Google Scholar]
  12. Jankovic J., Casabona J. Coexistent tardive dyskinesia and parkinsonism. Clin Neuropharmacol. 1987 Dec;10(6):511–521. doi: 10.1097/00002826-198712000-00002. [DOI] [PubMed] [Google Scholar]
  13. Jankovic J. Cranial-cervical dyskinesias: an overview. Adv Neurol. 1988;49:1–13. [PubMed] [Google Scholar]
  14. Jankovic J. Etiology and differential diagnosis of blepharospasm and oromandibular dystonia. Adv Neurol. 1988;49:103–116. [PubMed] [Google Scholar]
  15. Jankovic J., Schwartz K., Donovan D. T. Botulinum toxin treatment of cranial-cervical dystonia, spasmodic dysphonia, other focal dystonias and hemifacial spasm. J Neurol Neurosurg Psychiatry. 1990 Aug;53(8):633–639. doi: 10.1136/jnnp.53.8.633. [DOI] [PMC free article] [PubMed] [Google Scholar]
  16. Jankovic J. Tardive syndromes and other drug-induced movement disorders. Clin Neuropharmacol. 1995 Jun;18(3):197–214. doi: 10.1097/00002826-199506000-00001. [DOI] [PubMed] [Google Scholar]
  17. Jeste D. V., Lacro J. P., Palmer B., Rockwell E., Harris M. J., Caligiuri M. P. Incidence of tardive dyskinesia in early stages of low-dose treatment with typical neuroleptics in older patients. Am J Psychiatry. 1999 Feb;156(2):309–311. doi: 10.1176/ajp.156.2.309. [DOI] [PubMed] [Google Scholar]
  18. Kang U. J., Burke R. E., Fahn S. Natural history and treatment of tardive dystonia. Mov Disord. 1986;1(3):193–208. doi: 10.1002/mds.870010305. [DOI] [PubMed] [Google Scholar]
  19. Kiriakakis V., Bhatia K. P., Quinn N. P., Marsden C. D. The natural history of tardive dystonia. A long-term follow-up study of 107 cases. Brain. 1998 Nov;121(Pt 11):2053–2066. doi: 10.1093/brain/121.11.2053. [DOI] [PubMed] [Google Scholar]
  20. Klawans H. L., Tanner C. M. Cholinergic pharmacology of blepharospasm with oromandibular dystonia (Meige's syndrome). Adv Neurol. 1988;49:443–450. [PubMed] [Google Scholar]
  21. Molho E. S., Feustel P. J., Factor S. A. Clinical comparison of tardive and idiopathic cervical dystonia. Mov Disord. 1998 May;13(3):486–489. doi: 10.1002/mds.870130319. [DOI] [PubMed] [Google Scholar]
  22. Norwood C. Managed care reform--round one. Cranio. 1999 Jan;17(1):1–2. [PubMed] [Google Scholar]
  23. Nutt J. G., Muenter M. D., Aronson A., Kurland L. T., Melton L. J., 3rd Epidemiology of focal and generalized dystonia in Rochester, Minnesota. Mov Disord. 1988;3(3):188–194. doi: 10.1002/mds.870030302. [DOI] [PubMed] [Google Scholar]
  24. Sankhla C., Lai E. C., Jankovic J. Peripherally induced oromandibular dystonia. J Neurol Neurosurg Psychiatry. 1998 Nov;65(5):722–728. doi: 10.1136/jnnp.65.5.722. [DOI] [PMC free article] [PubMed] [Google Scholar]
  25. Shapleske J., Mickay A. P., Mckenna P. J. Successful treatment of tardive dystonia with clozapine and clonazepam. Br J Psychiatry. 1996 Apr;168(4):516–518. doi: 10.1192/bjp.168.4.516. [DOI] [PubMed] [Google Scholar]
  26. Stacy M., Cardoso F., Jankovic J. Tardive stereotypy and other movement disorders in tardive dyskinesias. Neurology. 1993 May;43(5):937–941. doi: 10.1212/wnl.43.5.937. [DOI] [PubMed] [Google Scholar]
  27. Tarsy D., Kaufman D., Sethi K. D., Rivner M. H., Molho E., Factor S. An open-label study of botulinum toxin A for treatment of tardive dystonia. Clin Neuropharmacol. 1997 Feb;20(1):90–93. doi: 10.1097/00002826-199702000-00012. [DOI] [PubMed] [Google Scholar]
  28. Tolosa E., Martí M. J. Blepharospasm-oromandibular dystonia syndrome (Meige's syndrome): clinical aspects. Adv Neurol. 1988;49:73–84. [PubMed] [Google Scholar]
  29. Valldeoriola F., González J., Vila N., Valls-Solé J., Solé M., Graus F., Tolosa E. Action myoclonus as an early clinical sign of carcinomatous meningitis. Mov Disord. 1996 Mar;11(2):223–225. doi: 10.1002/mds.870110219. [DOI] [PubMed] [Google Scholar]
  30. Wojcik J. D., Falk W. E., Fink J. S., Cole J. O., Gelenberg A. J. A review of 32 cases of tardive dystonia. Am J Psychiatry. 1991 Aug;148(8):1055–1059. doi: 10.1176/ajp.148.8.1055. [DOI] [PubMed] [Google Scholar]
  31. Yassa R., Nair V., Iskandar H. A comparison of severe tardive dystonia and severe tardive dyskinesia. Acta Psychiatr Scand. 1989 Aug;80(2):155–159. doi: 10.1111/j.1600-0447.1989.tb01319.x. [DOI] [PubMed] [Google Scholar]
  32. van Harten P. N., Hoek H. W., Matroos G. E., Koeter M., Kahn R. S. The inter-relationships of tardive dyskinesia, parkinsonism, akathisia and tardive dystonia: the Curaçao Extrapyramidal Syndromes Study II. Schizophr Res. 1997 Aug 29;26(2-3):235–242. doi: 10.1016/s0920-9964(97)00058-3. [DOI] [PubMed] [Google Scholar]

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