Treatment of a Tardive Dyskinesia Patient with Temporomandibular Disorder: A Case Report

This case report presents a patient with tardive dyskinesia who also suffered from masticatory muscle pain and temporomandibular joint osteoarthrosis. The patient was treated with clozapine in gradually increasing doses and two injections of botulinum toxin type A one year apart. Involuntary movements of mandibular clenching and bruxing disappeared and pain was relieved to a great extent. Reappearances of dyskinetic movements and pain were observed during the follow-up period of 1.5 years.

antipsychotic;botulinum toxin type A;clozapine;tardive dyskinesia;temporomandibular disorder

1. Blanchet PJ, Rompre PH, Lavigne GJ, Lamarche C. Oral Dyskinesia: A Clinical Overview. Int J Prosthodont 2005; 18:10–19.

2. Soares KV, McGrath JJ. The treatment of tardive dyskine-sia–a systematic review and meta-analysis. Schizophr Res 1999;39:1–18.

3. Tan EK, Jankovic J. Tardive and idiopathic oromandibular dystonia: A clinical comparison. J Neurol Neurosurg Psychiatry 2000;68:186–190.

4. Van Harten PN, Hovestadt A. Botulinum toxin as a treatment for tardive dyskinesia. Mov Disord 2006;21: 1276–1277.

5. Osborne TE, Grace EG, Schwartz MK. Severe degenerative changes of the temporomandibular joint secondary to the effects of tardive dyskinesia: A literature review and case report. J Craniomandib Pract 1989;7:58–62.

6. Kiriakakis V, Bhatia KP, Quinn NP, Marsden CD. The natural history of tardive dystonia: A long-term follow up study of 107 cases. Brain 1998;121:2053–2066.

7. Remington G. Tardive dyskinesia: Eliminated, forgotten, or overshadowed? Curr Opin Psychiatry 2007;20:131–137.

8. Wyngaarden JB, Smith LH (eds). Cecil Textbook of Medicine, ed 17. Philadelphia: WB Saunders, 1985: 2075–2076.

9. Smith J, Baldessarini R. Changes in prevalence, severity and recovery in tardive dyskinesias with age. Arch Gen Psychiatry 1980;37:1368–1373.

10. Margolese HC, Chouinard G, Kolivakis TT, Beauclair L, Miller R. Tardive dyskinesia in the era of typical and atypical antipsychotics. Part 1: Pathophysiology and mechanisma of induction. Can J Psychiatry 2005;50:541–547.

11. Myers DE, Schooler NR, Zullo TG, Levin H. A retrospective study of the effects of edentulism on the severity rating of tardive dyskinesia. J Prosthet Dent 1993;69:578–581.

12. Baldessarini RJ, Cole JO, Davis JM. Tardive dyskinesia: Summary of a task force report of the American Psy chiatric Association. Am J Psychiatry 1980;137:1163–1172.

13. Bassett A, Remick RA, Blasberg B. Tardive dyskinesia: An unrecognized cause of orofacial pain. Oral Surg Oral Med Oral Pathol 1986;61:570–572.

14. Ford B, Greene P, Fahn S. Oral and genital tardive pain syndromes. Neurology 1994;44:2115–2119.

15. Hierholzer RW. Tardive dyskinesia with complaints of pain. Am J Psychiatry 1989;146:802.

16. Ihde SK, Konstantinovic VS. The therapeutic use of botulinum toxin in cervical and maxillofacial conditions: An evidence-based review. Oral Surg Oral Med Oral Pathol Oral Radiol Endod 2007;104:e1–e11.

17. Margolese HC, Ferreri F. Management of conventional antipsychotic-induced tardive dyskinesia. Rev Psychiatr Neurosci 2007;32:72.

18. Jeynes LC, Gauci CA. Evidence for the use of botulinum toxin in the chronic pain setting. A review of the literature. Pain Pract 2008;8:269–276.

19. Rapaport A, Sadeh M, Stein D, Levine J, Sirota P, Mosheva T, et al. Botulinum toxin for the treatment of orofaciallingual-masticatory tardive dyskinesia. Mov Disord 2000;15:352–355.

20. Kanovsky P, Streitova H, Bares M, Hortova H. Treatment of facial and orolinguomandibular tardive dystonia by botulinum toxin A: Evidence of a long-lasting effect. Mov Disord 1999;14:886–888.

21. Mense S. Neurobiological basis for the use of botulinum toxin in pain therapy. J Neurol 2004;251(suppl 1):I1–7.

22. Castro WH, Gomez RS, Da Silva Oliveira J, Moura MD, Gomez RS. Botulinum toxin type A in the management of masseter muscle hypertrophy. J Oral Maxillofac Surg 2005;63:20–24.

23. Sutcher HD, Underwood RB, Beatty RA, Sugar O. Orofacial dyskinesia-A dental dimension. J Am Med Assoc 1971;216:1459–1463.

24. Gazerani P, Pedersen NS, Staahl C, Drewes AM, Arendt-Nielsen L. Subcutaneous botulinum toxin type A reduces capsaicin-induced trigeminal pain and vasomotor reactions in human skin. Pain 2009;141:60–69.

25. Margolese HC, Chouinard G, Kolivakis TT, Beauclair L, Miller R, Annable L. Tardive dyskinesia in the era of typical and atypical antipsychotics. Part 2: Incidence and man-agement strategies in patients with schizophrenia. Can J Psychiatry 2005;50:703–714.