Management of Refractory Orofacial Dyskinesia Caused by Anti-N-methyl-d-aspartate Receptor Encephalitis Using Botulinum Toxin
| Autor: | Zhong-Dong Lin, Xu-Lai Shi, Feixia Zheng, Neha Devi Poonit, Xiuyun Ye |
|---|---|
| Rok vydání: | 2018 |
| Předmět: |
0301 basic medicine
vecuronium pediatrics medicine.medical_treatment Case Report stereotypic movement disorder lcsh:RC346-429 03 medical and health sciences rituximab 0302 clinical medicine Cerebrospinal fluid Refractory mental disorders otorhinolaryngologic diseases medicine botulinum toxin lcsh:Neurology. Diseases of the nervous system business.industry Immunotherapy medicine.disease Botulinum toxin Stereotypic movement disorder dyskinesia 030104 developmental biology nervous system Neurology Dyskinesia Anesthesia Rituximab Neurology (clinical) anti-N-methyl-d-aspartate receptor encephalitis medicine.symptom business 030217 neurology & neurosurgery Encephalitis Neuroscience medicine.drug |
| Zdroj: | Frontiers in Neurology, Vol 9 (2018) Frontiers in Neurology |
| ISSN: | 1664-2295 |
| DOI: | 10.3389/fneur.2018.00081 |
| Popis: | The use of botulinum neurotoxin serotype A (BoNT-A) injections for the treatment of orofacial dyskinesia secondary to anti-N-methyl-d-aspartate receptor (NMDAR) encephalitis is rarely reported. Here, we report a case of an urgent, successful management of severe orofacial dyskinesia in an 8-year-old girl with anti-NMDAR encephalitis using BoNT-A injection. The patient presented with de novo unilateral paroxysmal movement disorder progressing to generalized dystonia and repetitive orofacial dyskinesia. Diagnosis was confirmed by the presence of NMDAR antibodies in serum and cerebrospinal fluid. The orofacial dyskinesia worsened despite the aggressive use of first-line immunotherapy and second-line immunotherapy (rituximab), and resulted in a potentially fatal self-inflicted oral injury. We urgently attempted symptomatic management using BoNT-A injections in the masseter, and induced muscle paralysis using vecuronium. The patient’s severe orofacial dyskinesia was controlled. We observed the effects of the BoNT-A injections and a tapering off of the effects of vecuronium 10 days after the treatment. The movement disorder had improved significantly 4 weeks after the first administration of rituximab. The injection of BoNT-A into the masseter may be an effective treatment for medically refractory orofacial dyskinesia in pediatric patients with anti-NMDAR encephalitis. We propose that the use of BoNT-A injections should be considered early to avoid self-inflicted oral injury due to severe refractory orofacial dyskinesia in patients with anti-NMDAR encephalitis. |
| Databáze: | OpenAIRE |
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