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To compare structural alterations in the brains of Meige syndrome (MS) patients with those of healthy controls (HCs) by using surface-based morphometry (SBM) and compare structural differences between the brains of MS patients with sleep disorders and those of MS patients without sleep disorders.
Methods:
We investigated cortical surface parameters in 42 MS patients and 30 HCs. T1-weighted images were acquired and processed using CAT12 to perform vertexwise between-group comparisons of cortical thickness, gyrification, cortical complexity and sulcus depth with validated quality control protocols. We also performed SBM to analyze data from 19 patients with sleep disorders and 23 patients without sleep disorders.
Results:
Compared with HCs, MS patients had differences in large clusters of cortical regions, especially in postcentral, precentral, superior frontal and paracentral thickness. Differences were also observed in the parietal and occipital areas. Among MS patients with and without sleep disorders, altered cortical complexity and sulcal depth were observed.
Conclusions:
This study strongly suggested that MS patients have cortical structural abnormalities compared with HCs, thus elucidating the underlying pathophysiology of motor and nonmotor symptoms in MS patients.
Oromandibular dystonia (OMD) is a form of focal dystonia that involves the masticatory, lower facial, labial and lingual musculature affected by the trigeminal, facial and hypoglossal cranial nerves. OMD can be classified into various subtypes, which include jaw-opening, jaw-closing, jaw-deviating, lingual, perioral and/or pharyngeal dystonia. Dystonic spasms may result in clenching, or trismus; grinding of the teeth, or bruxism; tongue thrusting; lip pursing; and other movements.
Evidence-based reviews and clinical experience strongly regard botulinum neurotoxin (BoNT) injection as the first-line treatment for OMD. Patients with OMD require careful examination to determine the particular muscles involved and their pattern of contraction to enable proper selection and targeting for BoNT injection. This chapter enumerates the particular muscles involved in each subtype of OMD, discusses localization and approach for injection and use of guidance techniques where applicable, and tabulates typical dose ranges for different formulations of BoNT. Typical adverse events and techniques to avoid them are discussed.