Botulinum Toxin A in Poststroke Oromandibular Dystonia: Case Reports

Background: Poststroke oromandibular dystonia (OMD) is a rare and challenging to treat form of dystonia. Botulinum toxin A (BoNT-A) is a standard treatment in other etiologies of OMD, but literature concerning a long-term potential beneficial role in posthemorrhagic stroke OMD is scarce. Cases: We present a case series of three patients with acute onset of multiple cranial nerve impairment and contralateral hemiparesis consequent to pontine hemorrhage. After a few months, all patients developed jaw-closing OMD (JC-OMD), conditioning a reduced mouth opening. Ultrasound-guided BoNT-A administration was started, and after 4 weeks, every patient showed clinical improvement. The results were maintained up to 10 years of follow-up, and no adverse event was reported. Conclusions: Poststroke OMD is an underestimated condition. Our cases provided data of safety and efficacy of BoNT-A treatment up to 10 years of follow-up. Further studies are warranted to establish etiopathological mechanisms and standardized treatments for poststroke JC-OMD.