Effects of Botulinum Toxin on Jaw Motor Events during Sleep in Sleep Bruxism Patients: A Polysomnographic Evaluation

Abstract

BRIEF SUMMARYCurrent Knowledge/Study Rationale: Botulinum toxin type A (BoNT-A) has been used for managing involuntary orofacial movements and secondary bruxism in patients with movement disorders, but its usefulness and objective effects on sleep bruxism (SB) have not been evaluated using objective measures. The aim of this study was to investigate the effects of intramuscular BoNT-A injection on orofacial motor events during sleep in patients with clinical diagnosis of SB. Study Impact: A single injection of BoNT-A into jaw-closing muscles is an effective strategy for controlling SB for at least a month. It reduces the intensity rather than the generation of the contraction in the jaw-closing muscles. Establishing management of SB with BoNT-A awaits further studies on larger samples over a longer follow-up period. Medicine, Vol. 10, No. 3, 2014 YJ Shim, MK Lee, T Kato et al equally effective in pain reduction when compared with oral splint. 17,18 The result of these studies and case reports were based on the subjective evaluation of SB, not on the objective assessment using electromyography (EMG) or polysomnography (PSG). A study using portable electromyographic (EMG) device showed that the counts of sleep related masticatory EMG bursts, detected by the pre-defined threshold, were significantly reduced after a single injection of BoNT-A in the masseter muscle. 19 However, it remains unclear how BoNT-A injection works specifically for sleep-related masticatory EMG activity, as a variety of jaw motor activities occur in association with transient arousal changes during sleep. 20 Video-polysomnography (vPSG) can be a useful tool allowing discrimination of the types of sleep-related masticatory EMG events. 2 In previous case reports and studies, some cases injected BoNT-A into the masseter muscle only, [13][14][15]17,18 and others into both the masseter and temporalis muscles. 10,11,15 The masseter and temporalis muscles are synergetic muscles and activated during teeth grinding and clenching; however, there have been no studies assessing the difference between the choices or the combination of the injected muscles for motor activity control of the jaw during sleep. 292 Journal of Clinical SleepTherefore, the aims of this study were to investigate the effects of intramuscular BoNT-A injection on jaw motor episodes using vPSG. In addition to the use of vPSG, we compared the effects of BoNT-A on jaw motor episodes between the injection sites (i.e., the masseter muscle injection only versus injection of both masseter and temporalis muscles). METHODS SubjectsThe protocol of this study was undertaken with the approval of Korea Food & Drug Administration and Institutional Review Board of the Yonsei University Dental Hospital. All subjects were informed of the nature of the study, and written consent was obtained from each participant.Twenty-four subjects (M: 10; F: 14, age: 20.2-38.7 years) were selected from among outpatients at the Department of Orofacial Pain and Oral Medicine, Yonsei University Dental Hospital. A...

Bruxism as a neurological problem (literature review)

“…доказательной медицины [21,30,31]. В этих исследо-ваниях БНП вводили либо Онаботулотоксин А в же-вательные и височные мышцы, либо Абоботулоток-син А в жевательную мышцу.…”

Bruxism and Current Treatment Approaches

“…Shim ve arkadaları, oral splint tedavisine yanıt vermeyen ağrılı ve ağrısız uyku bruksizmi olan hastalarda karılatırmalı bir çalıma yapmı ve her iki grupta da botoks enjekte edildiğinde ritmik çiğneme kas aktivitesi pik değerinin dütüğünü gözlemlemitir. Uyku bruksizmi olan hastaları kontrol etmede botoks kullanımının etkin bir yöntem olduğunu vurgulamıtır 98 . Bruksizm tedavisinde botoks uygulaması güncel bir yaklaım olmakla beraber bu konuda daha fazla randomize kontrollü çalımaya ihtiyaç vardır.…”

The Emerging Role of Botulinum Toxin in the Treatment of Orofacial Disorders: Literature Update

“…BTX-A injections by removing bruxism element reduce facial pain, TMD symptoms and can significantly help the other associated treatments of periodontal disease [45]. This has also been proven useful in sleep bruxism [46,47].…”