Oromandibular dystonia following antiemetic administration seen gradually and the dystonic attack caused the head to move towards left side repeatedly in a 12yrs boy having hepatitis A. The condition was managed by paediatrician via medication. But I am searching for physical therapy intervention in this case!
The antiemetic was probably metoclopramide and this sounds like one of those rare cases of dystonia resulting from sudden and severe dopaminergic dysregulation secondary to D2 antagonist treatment (the metoclopramide).
See, for example:
Article Metoclopramide-Induced Acute Dystonic Reaction: A Case Report
The patient in the above article also had hepatitis.
https://www.nps.org.au/australian-prescriber/articles/the-management-of-acute-dystonic-reactions
Good luck to you and your patient. Please tell us how it goes and if this was helpful.
Thank you for your valuable response to my question. I read the article you shared. The symptoms in the case study you shared was similar in the case I mentioned. The dystonic attack was purely Drug induced and was managed by withdrawal of that particular medication. Best Regards- Nihar Ranjan Mohanty
Thank you for your reply Dr. Mohanty - I'm glad my response was helpful.
It is interesting that both cases occurred in individuals with hepatitis A. If liver function was compromised, then perhaps diminished metabolic clearance resulted in toxic accumulation of the antiemetic? Probably too speculative of a supposition, at this point, I think. In any case, I am very glad your patient recovered - I believe I recall reading about cases of lifelong tardive dyskinesia following in-patient metoclopramide administration.
Hi,
Physical therapy modality including speech therapy, oral sensory devices and biofeedback, and so forth also have a positive role.
Speech therapists can offer training and communication aids to patients with oromandibular or laryngeal dystonia, and they can help in preventing complications in patients with transient dysphagia resulting from botulinum toxin injections.
https://books.google.com.tr/books?id=ksfsAwAAQBAJ&pg=PA297&lpg=PA297&dq=Oromandibular+dystonia?+Is+physical+therapy&source=bl&ots=LqCGVoXD88&sig=ACfU3U3QSNnVRYeh4yueGPl1IRk_-g9-rA&hl=tr&sa=X&ved=2ahUKEwjzkJuKhfPjAhUKWZoKHfx2DV8Q6AEwFXoECGMQAQ#v=onepage&q=Oromandibular%20dystonia%3F%20Is%20physical%20therapy&f=false
Article Management of Oromandibular Dystonia: A Case Report and Lite...
All the best,
Mehmet
Hello Dr. M. Güney Şenol,
Thank you for your valuable response. The article you shared is helpful.
best regards: NR MOHANTY
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