Department of Neurology, Ibn Sina Hospital, Kuwait.
Department of Medicine, Faculty of Medicine, Health Sciences Centre, Kuwait University, Kuwait.
Tremor Other Hyperkinet Mov (N Y). 2024 Jan 11;14:3. doi: 10.5334/tohm.849. eCollection 2024.
Focal task-specific dystonia is a form of isolated focal dystonia that occurs during the performance of a specific skilled motor task. The occurrence of oromandibular dystonia (OMD) specifically in association with the recitation of Quranic verses have been rarely reported in the literature, in non-native Arabic-speaking patients. This case series describe a rare type of focal task-specific dystonia that occurs exclusively by reciting Quran in native Arabic-speaking patients, which has never been reported, to the best of our knowledge.
In this case series, we identified five patients with new-onset OMD that was exclusively induced by reciting Quran. Cases were evaluated in our Movement Disorders outpatient clinic at Ibn Sina hospital; the main tertiary neurology center in Kuwait, between 2015 and 2023.
Five cases (3 males, 2 females) were identified in this study. Mean age of onset of the symptoms was 52.3 ± 4.1 years, while the median duration of the symptoms prior to diagnosis was 3 years. All patients were native Arab-speaking, with no previous history of other types of dystonia. No identifiable risk factors could be obtained including exposure to dopamine blocking agents or antipsychotics, or history of oral or dental surgery. Patients underwent a full clinical, laboratory, and radiological evaluation. All patients had OMD dystonia in varying forms and severity, while two patients had additional spasmodic dysphonia/ blepharospasm on progressive recitation. Most patients had minimal improvement with combination of oral medications and speech therapy. Four patients received botulinum toxin injections with better results.
The mental and physical stress in attempting to recite the Quranic verses could have contributed to the development of OMD. Moreover, the increased demand on the muscles of the jaw, lips, and tongue during recitation can trigger the dystonic symptoms.
OMD exclusively during Quran recitation is a rare phenomenon, and expands the spectrum of task-specific focal dystonia described in the literature. It was found to be distressing to the patients and a challenge to treat. Prompt recognition could minimize unnecessary testing and procedures, and facilitate earlier treatment.
局灶性任务特异性肌张力障碍是一种孤立性局灶性肌张力障碍，发生在执行特定技能性运动任务期间。在非母语为阿拉伯语的患者中，很少有文献报道口颌部肌张力障碍（OMD）特别是与诵读《古兰经》有关。本病例系列描述了一种罕见的局灶性任务特异性肌张力障碍，仅在母语为阿拉伯语的患者诵读《古兰经》时发生，据我们所知，这种情况以前从未有过报道。
在本病例系列中，我们鉴定了 5 例新发病例的 OMD，这些病例仅由诵读《古兰经》诱发。这些病例是在我们位于科威特主要三级神经病学中心 Ibn Sina 医院的运动障碍门诊评估的，病例鉴定时间在 2015 年至 2023 年之间。
本研究共鉴定了 5 例病例（3 例男性，2 例女性）。症状发作的平均年龄为 52.3 ± 4.1 岁，而在诊断前的症状中位持续时间为 3 年。所有患者均为母语为阿拉伯语，无其他类型肌张力障碍的既往病史。未发现任何可识别的危险因素，包括接触多巴胺阻断剂或抗精神病药物，或口腔或牙科手术史。患者接受了全面的临床、实验室和影像学评估。所有患者均有不同形式和严重程度的 OMD 肌张力障碍，而 2 例患者在逐渐诵读时出现痉挛性发音障碍/眼睑痉挛。大多数患者接受口服药物联合言语治疗后有轻微改善。4 例患者接受肉毒毒素注射治疗，效果更好。
试图诵读《古兰经》的精神和身体压力可能促成了 OMD 的发生。此外，在诵读期间，下颌、嘴唇和舌头肌肉的需求增加可能会引发肌张力障碍症状。
仅在诵读《古兰经》时出现的 OMD 是一种罕见现象，扩展了文献中描述的任务特异性局灶性肌张力障碍谱。它给患者带来困扰，治疗也具有挑战性。及时识别可以减少不必要的检查和操作，并促进更早的治疗。
