Botulinum neurotoxin a therapy efficacy and safety for oromandibular dystonia: a meta-analysis

  • Pariessa D. Dadgardoust
  • Raymond L. Rosales
  • Ria Monica Asuncion
  • Dirk Dressler
Neurology and Preclinical Neurological Studies - Original Article


Oromandibular dystonia (OMD) is a focal dystonia involving the mouth, jaw, and tongue. Botulinum neurotoxin (BoNT) therapy might be one form of treatment in OMD. Systematic pooling of BoNT studies in OMD remains wanting, as the derived data could provide useful information in regard to efficacy and safety issues. This meta-analysis determined the effects of botulinum neurotoxin type A (BoNT/A) on the reduction of dystonic movement and its safety among patients with OMD. A systematic search of the literature that met the following eligibility criteria were done: (1) patients treated with BoNT/A for OMD, (2) studies of high methodological quality and (3) outcome criteria specified as regard to efficacy. Risk of unresolved dystonia was computed before and after BoNT/A intervention. Random effect size (p < 0.05ɑ) and test of heterogeneity (< I2 50%) were computed as meta-analysis tool using REVMAN ver 5.3 program. Safety data, where available, were systematically reviewed. Nine studies involved 387 cases in total of OMD. The pooled risk ratio is 0.607 with a confidence interval of 0.371–0.783, a z value of 3.85, and a p value of 0.0001. Results indicate that risk of dystonic movements is lower by 39.30% in the treatment group than in the control group. A total of 105/387 patients (27.1%) experienced adverse events most commonly dysphagia. Whilst cited literatures have inherent weaknesses, results show that BoNT/A is efficacious in reducing dystonic movements of patients with OMD. Majority of studies employed electromyography (EMG) guidance in muscle targeting. Given the potential adverse event of dysphagia, one may take a cautious stand while delivering injections to target muscles. These findings are congruent with what has been published in regard to efficacy of BoNT/A in focal dystonia.


Oromandibular dystonia Lingual dystonia Perioral dystonia Botulinum toxin Botulinum toxin A Therapy 


Compliance with ethical standards

Conflict of interest

The authors of this study have nothing to disclose.


  1. Albanese A, Asmus F, Bhatia K, Elia AE, Elibol B, Filippini G, Gasser T, Krauss JK, Nardocci N, Newton A, Valls-Solé J (2011) EFNS guidelines on diagnosis and treatment of primary dystonias. Eur J Neurol 18:5–18. CrossRefPubMedGoogle Scholar
  2. Albanese A, Bhatia K, Bressman SB, Delong MR, Fahn S, Fung VSC, Hallett M, Jankovic J, Jinnah HA, Klein C, Lang AE, Mink JW, Teller JK (2013) Phenomenology and classification of dystonia: a consensus update. Mov Disord. CrossRefPubMedPubMedCentralGoogle Scholar
  3. Bakke M, Dalager T, Møller E (2016) What clinical strategies are applied for botulinum toxin injection in the oromandibular region?, Botulinum Toxin Therapy Manual for Dystonia and Spasticity, Raymond L. Rosales and Dirk Dressler, IntechOpen., Available from:
  4. Blitzer A, Greene PE, Brin MF, Fahn S (1989) Botulinum toxin injection for the treatment of oromandibular dystonia. Ann Otol Rhinol Laryngol 98(2):93–97. CrossRefPubMedGoogle Scholar
  5. Bhidayasiri R, Cardoso F, Truong D (2006) Botulinum toxin in blepharospasm and oromandibular dystonia: comparing different botulinum toxin preparations. Eur J Neurol 13(Suppl 1):21–29. CrossRefGoogle Scholar
  6. Charnukha T, Likhachev S, Navosha S (2016) Experience of botulinum toxin in treatment of oromandibular dystonia. Toxicon. CrossRefGoogle Scholar
  7. Dressler D (2012) Botulinum toxin therapy: its use for neurological disorders of the autonomic nervous system. J Neurol. CrossRefPubMedGoogle Scholar
  8. El-Tamawy M, Samir H (2010) Management challenges in oromandibular dystonia: the role of botulinum toxin-A. Egypt J Neurol Psychiatry Neurosurg 47:347–357Google Scholar
  9. Jankovic J, Schwartz K, Donovan DT (1990) Botulinum toxin treatment of cranial-cervical dystonia, spasmodic dysphonia, other focal dystonias and hemifacial spasm. J Neurol Neurosurg Psychiatry. CrossRefPubMedPubMedCentralGoogle Scholar
  10. Marques R, Duarte GS, Brogueira Rodrigues F, Castelão M, Ferreira J, Sampaio C, Moore AP, Costa J (2016) Botulinum toxin type B for cervical dystonia. Cochrane Database Syst Rev 5:CD004315. CrossRefGoogle Scholar
  11. Moher D, Cook DJ, Eastwood S, Olkin I, Rennie D, Stroup DF (2000) Improving the quality of reports of meta-analyses of randomised controlled trials: the QUOROM statement. Onkologie. CrossRefPubMedGoogle Scholar
  12. Odell K, Sinha UK (2012) Dystonia of the Oromandibular, Lingual and Laryngeal Areas, Dystonia, Raymond L. Rosales, IntechOpen. Available from:
  13. Persaud R, Garas G, Silva S, Stamatoglou C, Chatrath P, Patel K (2013) An evidence-based review of botulinum toxin (Botox) applications in non-cosmetic head and neck conditions. JRSM Short Rep. CrossRefPubMedPubMedCentralGoogle Scholar
  14. Rosales RL, Dressler D (2010) On muscle spindles, dystonia and botulinum toxin. Eur J Neurol 17(Suppl 1):71–80. CrossRefPubMedGoogle Scholar
  15. Rosales RL, Ng AR, Santos MMD-D, Fernandez HH (2011) The broadening application of chemodenervation in X-linked dystonia-parkinsonism (part II): an open-label experience with botulinum toxin-A (Dysport®) injections for oromandibular, lingual, and truncal-axial dystonias. Int J Neurosci 121:44–56. CrossRefPubMedGoogle Scholar
  16. Sankhla C, Lai EC, Jankovic J (1998) Peripherally induced oromandibular dystonia. J Neurol Neurosurg Psychiatry. CrossRefPubMedPubMedCentralGoogle Scholar
  17. Sinclair CF, Gurey LE, Blitzer A (2013) Oromandibular dystonia: long-term management with botulinum toxin. Laryngoscope. CrossRefPubMedGoogle Scholar
  18. Slaim L, Cohen M, Klap P et al (2018) Oromandibular dystonia: demographics and clinical data from 240 patients. J Mov Disord 11:78–81. CrossRefPubMedPubMedCentralGoogle Scholar
  19. Tan E-K, Jankovic J (1999) Botulinum toxin A in patients with oromandibular dystonia: long-term follow-up. Neurology. CrossRefPubMedGoogle Scholar
  20. Van den Bergh P, Francart J, Mourin S, Kollmann P, Laterre EC (1995) Five year experience in the focal movement disorders with low dose Dysport TM botulinum toxin. Muscle Nerve 18:720–729. CrossRefGoogle Scholar
  21. Yu GLT, Rosales RL (2018) Treatment of oromandibular dystonia using botulinum toxin injections—case series and illustrative muscle targeting. Basal Ganglia. CrossRefGoogle Scholar

Copyright information

© Springer-Verlag GmbH Austria, part of Springer Nature 2019

Authors and Affiliations

  • Pariessa D. Dadgardoust
    • 1
  • Raymond L. Rosales
    • 1
    • 2
  • Ria Monica Asuncion
    • 1
  • Dirk Dressler
    • 3
  1. 1.Department of Neurology and PsychiatryUniversity of Santo Tomas HospitalManilaPhilippines
  2. 2.The Neuroscience InstituteUniversity of Santo Tomas HospitalManilaPhilippines
  3. 3.Movement Disorders Section, Department of NeurologyHannover Medical SchoolHannoverGermany

Personalised recommendations