# A Case of Bilateral Auricular Dystonia With Both Sensory Trick and Reverse Sensory Trick Successfully Treated With Botulinum Toxin Therapy

## TL;DR

A 39-year-old man with a rare condition causing involuntary ear movements was successfully treated with botulinum toxin injections.

## Contribution

This case highlights the rare coexistence of two sensory tricks and their successful treatment with botulinum toxin.

## Key findings

- Bilateral auricular dystonia was successfully managed with botulinum toxin A injections.
- A sensory trick and a reverse sensory trick were both observed and treated in the same patient.
- Treating both the primary dystonia and the reverse sensory trick sites improved outcomes.

## Abstract

The patient was a 39-year-old male who presented to our hospital with a 15-year history of sustained involuntary movements of both auricles. A phenomenon suspected to be a sensory trick was observed, in which pressing on the frontal region above the eyebrows ceased the involuntary movements and was accompanied by compensatory contraction of the frontalis muscle. It was considered that this sensory trick, induced by pressure stimulation, led to the simultaneous occurrence of two distinct behaviors: the improvement of auricular dystonia and the emergence of involuntary contraction of the frontalis muscle. Botulinum toxin A was administered to both the auricular muscles and the frontalis muscle, resulting in favorable control of the symptoms.

Reports of bilateral auricular dystonia are exceedingly rare. Moreover, the concurrent appearance of two types of sensory tricks - one alleviating dystonia and the other exacerbating it - is also uncommon. When administering botulinum toxin A injection in such cases, it may be beneficial to consider not only for the primary dystonia but also for the sites where reverse sensory tricks manifest, potentially achieving better outcomes.