No AccessABSTRACTSPublished Online:August 5, 2013pp 208-361https://doi.org/10.1504/TBJ.2013.055660PDFView Full Text ToolsAdd to FavouritesDownload CitationsTrack Citations Share this article on social mediaShareShare onFacebookTwitterLinkedInReddit AboutAbstractObjective: To develop a webpage as a platform to facilitate flow of information amongst patients, therapists, and others for improvement of interdisciplinary therapy in movement disorders (MD).Methods: A webpage was created by Interdisciplinary Working Group for Movement Disorders (IAB – Interdisziplinärer Arbeitskreis Bewegungsstörungen) to support IAB’s mission: communication, education, and information for registered members and the public.Results: IAB’s webpage contains information about the following topics: 1) mission statement of IAB; 2) scientific board; 3) CME points and certificates for health professionals; 4) partners and mutual links; 5) IAB regional groups, their organisation, their meetings, their special interests and protocols of their sessions; 6) IAB communication and education tools such as the communication form to facilitate flow of information about treated patients amongst different MD therapists and the communication calendar for botulinum toxin therapy of spasticity; 7) special events such as a Parkinson café for patients; 8) publications, presentations, projects and job advertisements of IAB and IAB members; 9) news box; 10) IAB contact for applications for membership and partnership, registration for meetings, purchase of products; 11) database of members and their professions, specialties and contact data open to members only or to the public.Conclusions: IAB’s webpage improves communication amongst MD therapists, patients and the public. It provides education and information for all concerned with MD.Keywordsmultidisciplinary approachwebpagecommunicationeducationinformationAbstractObjective: To assess the effectiveness of rimabotulinumtoxin B (rbtxB) in treating sialorrhea associated with Parkinson disease (PD).Background: Sialorrhea is a common non-motor symptom of PD that disrupts the quality of life of patients affected, including social embarrassment and increased risk for aspiration. Oral medications may be effective, but have unwanted adverse effects, primarily anticholinergic, limiting their tolerability. Directed injections of botulinum toxin into salivary glands can provide similar or improved relief of sialorrhea compared to oral medications, without the associated adverse effects.Methods: Case series. Thirteen PD patients (12 male, 1 female) with severe sialorrhea were surveyed using a seven-point Patients’ Global Impression of Change (PGIC) scale to assess the change in sialorrhea following rbtxB injections. All PD patients had received two to four cycles of intraparotid rbtxB injections repeated every three months with total dose range 2,500–5,000 units. All were on oral medications to control their motor symptoms. Patient spouses (N = 12) also completed the PGIC survey to provide their assessment of clinical change observed.Results: PGIC scores of 1–4 were considered no significant change, and 5–7 a significant favourable response. PD patients’ PGIC scores ranged from 2–7; 9 (69%) scored 5–7. Spouse PGIC scores ranged from 3–7; 10 (77%) scored 5–7. Two patients with no improvement are now on oral or transdermal medications to treat sialorrhea. No adverse effects to rbtxB were reported.Discussion: Intraparotid rbtxB injections can produce significant improvement in sialorrhea associated with PD.Keywordsrimabotulinumtoxin BsialorrheaParkinson diseaseAbstractBackground: Clinically, spasticity has proven hard to measure. Current measures are categorical, show poor sensitivity, and have questionable reliability. Dynamic computerised dynamometry (DCD) has been proposed as a means of overcoming some of these limitations. This paper explores whether DCD can identify patterns of botulinum toxin A (BTX) response in subjects with acquired brain injuries (ABI).Methods: Assessments were completed on 27 healthy controls and 38 subjects with ABI using published DCD paradigms. 2/3 of ABI subjects were assessed pre/post-BTX. Ten cycles of maximum force and speed grasp/release cycles were collected and the sequential minimum between-cycle force analysed for each participant. Data were then grouped according to response pattern.Results: The mean minimum between-cycle force was significantly lower for controls than ABI subjects (0.5 kg vs. 2.9 kg, Z = –4.6, P < .05). Controls showed an average 3% reduction of minimum force from each cycle to the next. ABI participants showed two response patterns; 12 subjects (32%) followed an equivalent pattern, averaging a 5% force reduction across cycles. Conversely, 26 subjects (68%) showed an average 12% increased effort across each cycle (see Figure 1). Group responses were different following BTX.Conclusions: ABI participants had higher between-cycle minima than controls, evidence of muscle over-activity. However, two response patterns were seen; one equivalent to healthy controls (where force decreases as the person learns the task) and one where muscle activity increases with ongoing use. While BTX marginally reduced force in the initial cycle, it prevented the movement-inducible component of spasticity. The clinical usefulness of this effect is yet to be explored.Keywordsbotulinum toxindynamic computerised dynamometryDCDspasticityAbstractIntroduction: Although the functional imbalance in cervical dystonia has traditionally been regarded as a basal ganglia dysfunction, recently there has been provoking evidence of cerebellar involvement in pathophysiology of this focal dystonia. Even in absence of traditional ‘cerebellar signs’ in most dystonia patients, there are more subtle indications of cerebellum dysfunction. This project tries to provide more information about such dysfunction pointing towards considerable cerebellar involvement in etiopathogenesis of this disease – concretely disrupted ability to precise time movements (Jinnah and Hess, 2006).Methods: Thirty patients with cervical dystonia treated with botulinum toxin-A (BTX-A) and 30 healthy controls of comparable age and sex structure, performed series of simple computer tasks (Bares et al., 2011). The duration of cervical dystonia symptoms was 4.3 ± 1.2 years, the duration of BTX-A treatment 2.3 ± 1.4 years. The software pseudorandomly generated parameters (speed, acceleration, partially the movement direction) of a moving object – a green ball. As it moved on the computer screen from left to right, the participant had to press a button in an optimal time window to launch a projectile from the bottom of the screen that was supposed to hit the moving target. The speed of the projectile was constant (as was the trajectory) and much higher than the speed of the green ball. However, it was not sufficient to ignore the launch-interception time and therefore the subject had to anticipate the precise launch time to hit the green ball, taking into account not only the constant parameters, but the changing ones as well.We evaluated the overall hit ratio, percentage of early and late errors, the hit ratio in specific parameter sets (acceleration vs. deceleration or constant speed of the green ball, high vs. low speeds of the green ball, etc.) and many others.Results: The overall hit ratio in the healthy subjects was significantly higher than in the cervical dystonia group (42.07% ± 9.18% versus 34.91% ± 8.23%). Cervical dystonia patients encountered difficulties in dealing with acceleration/deceleration of the target and could not benefit from lower speeds of the flying target as much as the control group.Conclusions: The data suggest that cervical dystonia patients treated with BTX-A have a substantial problem with predictive motor timing (Husárová et al., 2011). The results imply that cerebellum and basal ganglia participate in the integration of visual information with motor output. We plan to test subgroup of cervical dystonia patients before the initiation of BTX-A treatment.This work was supported by the ‘CEITEC – Central European Institute of Technology’ project (CZ.1.05/1.1.00/02.0068) from the European Regional Development Fund and by Ministry of Health of the Czech Republic/Ministry of Health’s Departmental Research and Development Programme III (2010–2015) NT/13437.Keywordsbotulinum toxin Acervical dystoniamotor timingmovement controlAbstractStudy objective: To report the effect of botulinum toxin injection (BTI) type A (XEOMIN®) into pelvic floor muscle on symptoms of patients presenting perineal pain associated with pelvic floor muscle overcontraction and myalgia at clinical examination.Patients: 420 patients (294 women and 126 men) identified with levator ani and/or obturator internus and/or perineal superficial muscles (bulbocavernosus, ischiocavernosus) overcontraction and myalgia with trigger points along the muscles. All of them presented with symptoms of perineal, vulval, vaginal, urethral, testicular, anal and/or inguinal pain. Pain was most of the time described as burning sensation or spasm. Dysfunction associated with the pain ranged from dysuria, terminal constipation, dyspareunia to painful ejaculation in men. Criteria of pudendal neuralgia were also examined according to the Aix-en-Provence criteria.Intervention: Patients were injected with 100 to 400 IU of XEOMIN®, over a period of three years from December 2008 to December 2011, into one or both levator ani and/or obturator internus muscles and/or perineal superficial muscles. The maximum injected was 400 IU in total. Muscle injections were performed under electro-myo-stimulation and/or ultrasound control.Results: All the patients had a physical therapy muscle relaxation programme before and after the BTI. Patients were evaluated on their pain level (VAS), muscle relaxation and trigger point. There were very few adverse events: five women had a worsening of their vaginal prolapse and eight women out of 294 experienced a short period of urinary or fecal incontinence (2.7%). Of 397 patients who came back, 370 (93%) patients had an improvement of their muscle overcontraction and myalgia. 308 patients (78%) had their pain improved going from slight improvement to no pain. 119 patients had their pain starting after a physical trauma (sport trauma, fall, or traumatic delivery) and 108 (91%) of them had an improvement of their pain. Of 58 women who had associated provoked vulvodynia, 47 (82%) were improved. 178 patients had also a diagnosis of pudendal neuralgia. The neuropathic pudendal pain was improved in 57%. 76 had no change after injection (43%) and 70 patients needed pudendal nerve releasing surgery for nerve entrapment. Dysuria was improved in 92%, obstructed defaecation syndrome in 72%, painful ejaculation in 96%, erectile dysfunction in 70%.Keywordsbotulinum toxin injectionmyalgiaperineal painAbstractIncobotulinumtoxinA, a botulinum neurotoxin free of complexing proteins, has proven efficacious and safe in the treatment of focal dystonias. Using a 1U:1U dosing ratio, equivalent efficacy of incobotulinumtoxinA to onabotulinumtoxinA was demonstrated in a multicentre, double-blind, randomised study in cervical dystonia. The protocol prespecified the two-sided 95% confidence interval (CI) method for testing the hypothesis of equivalence of incobotulinumtoxinA to onabotulinumtoxinA expressed by the change from baseline in the TWSTRS severity score four weeks after intramuscular injections of either neurotoxin. The difference between treatment groups was determined in the per-protocol population (n = 240) using least square means and corresponding two-sided 95% CIs. The clinically irrelevant difference was set to Δ = 1.3 points predefining the therapeutic equivalence range as (–1.3, 1.3). An analysis of covariance model included baseline TWSTRS severity score, country, gender and age as factors for the confirmatory analysis. Both treatments significantly (P < .0001) reduced the TWSTRS severity score: –6.6 ± 4.1 (incobotulinumtoxinA) and –6.4 ± 3.9 (onabotulinumtoxinA). The LS mean difference between the treatments was –0.33, slightly in favour of incobotulinumtoxinA. The 95% CI (–1.05, 0.38) was below the irrelevant difference and thus demonstrates statistically that incobotulinumtoxinA is equivalent to onabotulinumtoxinA. The prespecification of a two-sided 95% CI and an irrelevant difference and a statistical argument based on the closed test procedure allow the conclusion of therapeutic equivalence since the CI is fully contained in the equivalence range. Therefore, the study shows therapeutic equivalence in efficacy in the treatment of cervical dystonia in the administered dose range when used with a 1U:1U conversion ratio.Keywordsbotulinum neurotoxinincobotulinumtoxinAonabotulinumtoxinAcervical dystoniaAbstractBackground: Little data exist regarding patient satisfaction with botulinum toxin treatment in patients with poststroke spasticity. To address this question, a structured patient survey was conducted in Germany, France, the USA, and Canada.Methods: Patients with poststroke spasticity treated with at least two injection cycles of either onabotulinumtoxinA or abobotulinumtoxinA were included in this cross-sectional survey. Specific information was collected on the patients’ current and prior botulinum toxin treatment cycles and their overall quality of life.Results: Seventy-six patients with poststroke spasticity participated. Only 42.1% of patients were very satisfied with their current treatment, 46.1% were somewhat satisfied, and 11.8% were not at all satisfied. Patient satisfaction was lowest just prior to injection and highest at the time of peak effect. A total of 45.2% of patients reported that they would prefer a treatment cycle of < 12 weeks. The mean patient rating of current state of health was 53.5 (±22.4 standard deviation) on a visual analogue scale from 0 (low) to 100 (high).Conclusions: The results from the patient survey indicate that patient satisfaction typically declines prior to reinjection with botulinum toxin, and many patients may prefer an injection interval of less than the standard 12 weeks.Keywordsbotulinum toxinpoststroke spasticitycross-sectional surveyAbstractBackground: Little data exist regarding physician satisfaction with botulinum toxin treatment in patients with poststroke spasticity. To address this question, a structured physician survey was conducted in Germany, France, the USA, and Canada.Methods: Physicians who treated patients with poststroke spasticity with botulinum toxins were included in this cross-sectional survey. Specific information regarding their satisfaction with botulinum toxin treatment was collected.Results: One hundred and five physicians participated. Most physicians were moderately (58%) or very satisfied (37%) with botulinum toxins. However, physicians felt that 16.2% of poststroke patients could benefit from shorter injection intervals and 24.6% could benefit from higher maximum doses than current treatment restrictions permit.Conclusions: The results from this physician survey indicate that most physicians are generally satisfied with botulinum toxin treatment; however, many physicians feel that there is still a proportion of patients who could likely be more effectively treated if shorter treatment intervals and higher doses were used.Keywordsbotulinum toxinpoststroke spasticitycross-sectional surveyAbstractDeficiency of intracortical inhibition is the keystone of pathophysiology in dystonia. In the Brunel and Wang realistic cortical network model of interneurons and excitatory pyramidal cells that are interconnected in reentrant loops, the dominant neuronal oscillation frequency is gamma in the frequency of 30–100 Hz [J. Neurophysiol., (2003), Vol. 90, p.415]. Gamma band fluctuations in magnetoencephalography (MEG) have been shown to be positively correlated with GABA concentration [Pro. Natl. Acad. USA, (2009), Vol. 106, p.8356]. The aim of the present MEG study was to determine whether treatment with botulinum toxin would affect the gamma band brain activity in torticollis patients.Methods: In seven torticollis patients, whole head magnetoencephalography (MEG) was recorded in a resting-state condition before and after treatment with botulinum toxin. Coherence was calculated in the gamma frequency band. Discriminant analysis was used to determine if gamma locations were altered after treatment.Results: After treatment with botulinum toxin, torticollis patients demonstrated decreased gamma band coherence in the right middle temporal and right inferior temporal gyrus together with an increase in gamma band coherence in the left middle frontal gyrus, left pre- and post-central gyri. Discriminant analysis was used to identify group differences with P < .01 based on 86 out of 4,168 locations in the brain.Conclusions: Treatment with botulinum toxin increases gamma activity in the pre- and post-central gyrus restoring cortical inhibition, which in turn reduces the symptoms of torticollis. Gamma band increases may reflect a direct increase in GABA concentration in this region.Keywordsbotulinum toxintorticollismagnetoencephalographyMEGgamma bandAbstractObjective: To compare the distal spread of onabotulinumtoxin A (obtxA) and rimabotulinumtoxin B (rbtxB) in humans using single-fibre electromyography (SFEMG).Background: Botulinum toxin (btx) is an effective therapy for a variety of neurologic conditions. Distal spread of btx to non-injected muscles is an undesirable side effect. Prior studies have compared spread effects of different toxin serotypes using CMAP amplitude variation. SFEMG is a more sensitive measure of neuromuscular junction blockade. Comparing the spread of different btx serotypes using SFEMG may assist clinicians in choosing between serotypes for use.Methods: Twelve patients with migraine headaches were studied; six received obtxA (120 units) and six received rbtxB (6,000 units) distributed over 15 sites of the face and neck. SFEMG was performed on a distal muscle (extensor digitorum communis) prior to, and 30-days following, injections. The patients and electromyographer were blinded to serotype used. The jitter [mean consecutive discharge (MCD)], percentage of abnormal muscle fibre pairs, and percentage of pairs demonstrating blocking were compared between groups.Results: Baseline average MCD for each group was similar: obtxA 31.8 mcs; rbtxB 30.2 mcs. Average MCD 30 days following treatment was: obtxA –0.2 mcs; rbtxB 4.0 mcs (P = .75). The average change in percentage of abnormal pairs was: obtxA +4.2%; rbtxB +7.5% (P = .83). There was no difference in blocking for either group. No patient reported muscle weakness.Conclusions: Our study demonstrated no significant remote SFEMG differences between obtxA and rbtxB. Small absolute differences were seen between baseline and 30-day follow-up for each group. No weakness was reported by any patient regardless of SFEMG change.Keywordsbotulinum toxinonabotulinumtoxin Arimabotulinumtoxin Bsingle-fibre electromyographySFEMGAbstractIn the literature, few reports exist about peripheral myoclonus involving the injury of different nerves. Involuntary movements of pectoralis muscles in patients who had mastectomy for breast cancer are extremely rare. We describe a case of a 60-year-old woman who underwent left mastectomy and implantation of a breast prosthesis; six months later she began feeling pain and movement disorder in the pectoralis region on the left and she had to remove the prosthesis. She complained of very high distress.A surface poly EMG of the pectoralis area and a needle EMG showed at rest or during voluntary movement bursts of 500 msec to 4 sec, amplitude 200–500 micron volt with asynchronous repetition in particular in the sternocostal region of pectoralis muscles. As a symptomatic therapy of the painful and distressing movement disorder she underwent, with US/EMG guide, a treatment with OnabotulinumtoxinA 100 U diluted in 1 ml of physiological solution in six points, three in the major and three in the minor left pectoralis muscle.After two weeks the patient described reduced pain in the pectoralis left region (VAS 2), less global discomfort and an EMG needle recording showed a reduced amplitude and duration, of the involuntary movement with lower frequency of myoclonus. After four weeks there was a nearly complete resolution of the JB and np pathological activity at the EMG.Botulinum toxin A could be a useful treatment of rare cases of spinal myoclonus. A very precise clinical and neurophysiological evaluation is mandatory and it is useful to use US and EMG techniques to perform a good targeting of the muscles involved in the movement disorder.Keywordsbotulinum toxinmastectomybreast prosthesismovement disordermyoclonusAbstractWe are presenting the results of our 12 years of experience using BtA (Dysport®) as a part of the comprehensive rehabilitation programme for children with various forms of cerebral palsy (CP) in Kazakhstan.Methods: In total, more than 3,000 children had the injections. According to the type of CP, 38.2% of children had the double hemiplegic type, 31.6% had the spastic diplegic type, 23.8% had hemiparetic type, 11.1% had the mixed type, and 7.5% astatic-atonic type. To assess the programme effectiveness the subjective scale of physical and psycho-emotional wellbeing (0–100%), gross motor function classification system (GMFCS) and Ashwart scale were used.Results: The treatment group (n = 40) also received Dysport® injections while the control group (n = 40) did not.Table 1 Ashwart scale in intervention and control groups on admission and on dischargeCP typeTreatment group, n = 40Control group, n = 40On admissionOn dischargeOn admissionOn dischargeDouble hemiplegia (n = 8)3.42.12.61.7Spastic diplegia (n = 10)3.62.61.91.5Mixed diplegia (n = 10)3.22.41.71.2Hemiparetic (n = 12)3.42.532M ± m3.4 ± 0.12.4 ± 0.152.1 ± 0.51.6 ± 0.25t5.55.50.84P< 0.001>0.05Table 2 GMFCS in intervention and control groups on admission and on dischargeCP typeTreatment group, n = 40Control group, n = 40On admissionOn dischargeOn admissionOn dischargeDouble hemiplegia (n = 8)4.13.23.63Spastic diplegia (n = 10)3.62.62.11.6Mixed diplegia (n = 10)3.43.21.61.5Hemiparetic (n = 12)3.32.52.51.6M ± m3.6 ± 0.252.87 ± 0.322.45 ± 0.61.9 ± 0.54t4.30.81p< 0.001> 0.05Conclusions: Our experience showed that injections of BtA (Dysport®) are effective in all types of CP manifesting by increased muscle tone, spasticity, dystonia, and hyperkinesia. In cases of hyperkinetic syndromes the severity decreased as well so children could sit better and gained better voluntary motor control. In our experience the best results were obtained if the BtA injections were initiated in the early childhood when the first signs of muscle hypertonicity and spasticity start to appear.Keywordsbotulinum A toxinDysport®cerebral palsyhyperkinetic syndromeAbstractObjective: To review the evidence for the use of abobotulinumtoxinA (ABO) in upper and lower limb spasticity, blepharospasm, hemifacial spasm, sialorrhea, writer’s cramp and truncal dystonia.Methods: A systematic literature search (PubMed, Cochrane Library, EMBASE) was performed to identify randomised controlled trials and other comparative clinical studies of ABO published between 1991 and January 2012. Study methodology, patient, and treatment-level data were extracted and summarised using descriptive statistics. Each included study underwent quality assessment for bias based on Cochrane metrics.Results: A total of 28 studies met the data extraction eligibility criteria. All included studies were randomised clinical trials with the exception of one study (observational comparative) for hemifacial spasm. Of the 28 studies, 20 focused on adult spasticity (12 upper limb, eight lower limb) of various origins (17 post-stroke, three others). The other studies were: two each in blepharospasm, hemifacial spasm, and sialorrhea; one each in truncal dystonia and writer’s cramp. Overall, ABO demonstrated clinically or statistically significant efficacy for each disorder. The majority of studies fulfilled criteria for low risk of reporting bias. Total ABO doses ranged between 500–1,500 U for upper limb spasticity; 50–2,000 U for lower limb spasticity; 100–182 U for blepharospasm; 51–70 U for hemifacial spasm; 37.5–450 U for sialorrhea; 500 U for truncal dystonia and 178 U for writer’s cramp.Conclusions: Based on data extracted from 20 randomised clinical studies, a strong evidence base exists for the use of ABO in limb spasticity. Based on data from eight studies, ABO appears efficacious for blepharospasm, hemifacial spasm, sialorrhea, truncal dystonia, and writer’s cramp.KeywordsabobotulinumtoxinAbotulinum toxinblepharospasmhemifacial spasmspasticitysialorrheadystoniawriter’s crampsystematic reviewAbstractBackground: The usefulness of electromyography (EMG) for botulinum neurotoxin (BoNT) injections for cervical dystonia (CD) is controversial. Frequency of EMG utilisation has not been previously described from a large, prospectively ascertained treatment cohort.Methods: The CD PROBE study is an ongoing observational study of CD treated with onabotulinumtoxinA that includes physicians with prior injection experience. Subjects were included if they had primary CD and were new to the treating physician’s practice, had not received toxin for greater than or equal to 16 weeks, or were toxin naïve. This analysis was designed to describe the use of EMG by physicians at the baseline (first) injection.Results: The CD PROBE study has enrolled 1030 CD subjects; 75% women, mean age 58.0 ± 14.6 years, duration of CD 5.0 ± 8.1 years, total TWSTRS score 38.7 ± 13.1. In this group, 47.6% had predominant torticollis, 39.3% laterocollis, 5.4% anterocollis, and 5.2% retrocollis. There were 85 treating physicians who have been using BoNT for a mean of 12.2 ± 5.4 years, 89% of whom were neurologists. 81% of the physicians used EMG for the injection. When EMG was used, a greater number of muscles was injected than when injections were done without EMG (4.1 ± 1.3 vs. 3.6 ± 1.4; P < .0001).Conclusions: This subanalysis of the CD PROBE study shows that most treating physicians in the CD PROBE study utilise EMG for CD injections, but additional analyses are needed to determine whether outcomes differ between patients injected with or without EMG.Keywordsbotulinum neurotoxinBoNTcervical dystoniaelectromyographyEMGonabotulinumtoxinAAbstractBackground: Intramuscularly administered onabotulinumtoxinA is an effective treatment for a variety of movement disorders. Severe bruxism, which can generate discomfort, pain, tongue laceration, and tooth fragmentation, is a frequent complication of anoxic brain injury. Severe bruxism is usually amenable to medical treatment. We report successful symptomatic treatment of severe bruxism with onabotulinumtoxinA in four patients with anoxic brain injury.Methods: Four patients were seen on the inpatient and/or outpatient service at Henry Ford Health System between November 2003 and August 2011. All four patients were females. Ages ranged from 23 to 63 years old.Results: All four patients received onabotulinumtoxinA injection to the bilateral masseter and/or temporalis muscles (total of 50–100 units were injected during each visit). Two of the four patients received multiple injections separated by two weeks to three months due to severity of the symptoms. All four patients responded positively to the injections. No side effects were reported in any of the studied patients.Conclusions: OnabotulinumtoxinA injections are an efficacious and valuable treatment for patients with severe bruxism post anoxic brain injury.KeywordsonabotulinumtoxinAsevere bruxismanoxic brain injuryAbstractBackground: The American Academy of Sleep Medicine defines bruxism as a stereotyped oral motor disorder characterised by clenching, grinding, bracing, and gnashing of the teeth during sleep, and American Academy of Orofacial Pain has extended the definition during wakefulness. Jaw closing dystonia refers to the co-contraction of the bilateral masseter and temporalis muscles that may result in clenching, grinding, and trismus. Like other types of focal dystonia, the spasm and muscle contraction can be constant or spasmodic. In this comparative analysis, we assess differences and similarities in etiology, pathophysiology, clinical manifestations, management, and prognosis between bruxism and jaw closing dystonia.Methods: Medline and current textbooks of sleep medicine and neurology were searched for relevant information. Search terms: bruxism, oromandibular dystonia, and jaw closing dystonia.Results: Similar pathophysiology and clinical manifestation were found in different literature regarding these two ostensibly distinct clinical entities. In both entities, the involvement of the nigrostriatal system was shown in multiple separate studies. Clinical outcome and response to the therapy by chemodenervation with botulinum toxins was similar as well.Conclusions: This comparative analysis suggests that bruxism and jaw closing dystonia follow the same pathophysiology, clinical manifestations and outcome. It seems that we are naming the same clinical entity differently in the dentistry, orofacial medicine, and neurology literature. We believe that bruxism is a spasmodic subtype of the jaw closing dystonia.Keywordsbotulinum toxinbruxismjaw closing dystoniaoromandibular dystoniaAbstractThe voltage-gated potassium channel Kv inhibitor 3,4 diaminopyridine (3,4-DAP) has been examined in the treatment of human botulism outbreaks. In a diaphragm muscle paralysed by BoNT/A, but not BoNT/E exposure, 3,4-DAP induces a rapid and pronounced increase in twitch tensions highlighting the role of the K+ channels in transmitter release and BoNT/A mechanism of action.In the present stu