Bruxism in patients of moderate to severe traumatic brain injury: Management results suggesting an etiological mechanism

Abstract

IntroductionBruxism is an unusual event among patients of altered sensorium after brain injury. Occasionally the bruxism may be so severe as to cause harm to the patients and make nursing difficult. This study presents such cases that were managed by the author. A possible explanation for post-brain injury bruxism is suggested. Material and methodTwelve patients of brain injury following trauma who were observed to have bruxism were included in the study. The clinical presentation and the response to intervention were studied. Patients less then 16 years were managed with benzodiazepines only. Patients more than 16 years of age were managed with benzodiazepines and pramipexole was administered in addition to benzodiazepines in 5 patients. ObservationOf the 12 patients 3 subjects were classified as severe brain injury. Nine patients had suffered moderate grade brain injury. 3 (25%) patients were children and the mean age of the rest 9 (75%) patients was 40 years. The children were managed with benzodiazepines. The median time of onset of bruxism from the time of injury was 5.25 days with range of 2 days–12 days. Pramipexole, a dopamine agonist, was useful in management of severe bruxism with a latency period of 2 days. All patients except one recovered within 7 days after starting the treatment. ConclusionBruxism is distressing to a patient-in-recovery following brain injury and cause significant inconvenience to the nursing staff. Effective treatment included the use of benzodiazepines and pramipexole. Pramipexole, a dopamine receptor agonist, should be considered an option for pharmacological management of bruxism after brain trauma. If central pattern generators (CPG) are involved in some of the disabilities of moderate to severe brain injuries like bruxism, there is a rationale for considering a larger study for the use of dopamine receptor agonist in such patients.