Scorr Laura M, Factor Stewart A, Parra Sahyli Perez, Kaye Rachel, Paniello Randal C, Norris Scott A, Perlmutter Joel S, Bäumer Tobias, Usnich Tatiana, Berman Brian D, Mailly Marie, Roze Emmanuel, Vidailhet Marie, Jankovic Joseph, LeDoux Mark S, Barbano Richard, Chang Florence C F, Fung Victor S C, Pirio Richardson Sarah, Blitzer Andrew, Jinnah H A
Department of Neurology, Emory University, Atlanta, GA, United States.
Department of Otolaryngology, Rutgers University, Newark, NJ, United States.
Front Neurol. 2021 Sep 16;12:700714. doi: 10.3389/fneur.2021.700714. eCollection 2021.
The goal of this study is to better characterize the phenotypic heterogeneity of oromandibular dystonia (OMD) for the purpose of facilitating early diagnosis. First, we provide a comprehensive summary of the literature encompassing 1,121 cases. Next, we describe the clinical features of 727 OMD subjects enrolled by the Dystonia Coalition (DC), an international multicenter cohort. Finally, we summarize clinical features and treatment outcomes from cross-sectional analysis of 172 OMD subjects from two expert centers. In all cohorts, typical age at onset was in the 50s and 70% of cases were female. The Dystonia Coalition cohort revealed perioral musculature was involved most commonly (85%), followed by jaw (61%) and tongue (17%). OMD more commonly appeared as part of a segmental dystonia (43%), and less commonly focal (39%) or generalized (10%). OMD was found to be associated with impaired quality of life, independent of disease severity. On average, social anxiety (LSA score: 33 ± 28) was more common than depression (BDI II score: 9.7 ± 7.8). In the expert center cohorts, botulinum toxin injections improved symptom severity by more than 50% in ~80% of subjects, regardless of etiology. This comprehensive description of OMD cases has revealed novel insights into the most common OMD phenotypes, pattern of dystonia distribution, associated psychiatric disturbances, and effect on QoL. We hope these findings will improve clinical recognition to aid in timely diagnosis and inform treatment strategies.
本研究的目的是为了便于早期诊断,更好地描述口下颌肌张力障碍(OMD)的表型异质性。首先,我们对涵盖1121例病例的文献进行了全面总结。其次,我们描述了国际多中心队列肌张力障碍联盟(DC)纳入的727例OMD受试者的临床特征。最后,我们总结了来自两个专家中心的172例OMD受试者横断面分析的临床特征和治疗结果。在所有队列中,典型发病年龄为50多岁,70%的病例为女性。肌张力障碍联盟队列显示,口周肌肉组织受累最为常见(85%),其次是下颌(61%)和舌(17%)。OMD更常表现为节段性肌张力障碍的一部分(43%),较少表现为局灶性(39%)或全身性(10%)。研究发现,OMD与生活质量受损有关,与疾病严重程度无关。平均而言,社交焦虑(LSA评分:33±28)比抑郁(BDI II评分:9.7±7.8)更常见。在专家中心队列中,无论病因如何,约8