# Botulinum Toxin A in Poststroke Oromandibular Dystonia: Case Reports

## TL;DR

This paper reports on three patients with poststroke oromandibular dystonia who showed long-term improvement after botulinum toxin A treatment.

## Contribution

The study provides long-term evidence (up to 10 years) of botulinum toxin A's safety and efficacy in treating poststroke jaw-closing dystonia.

## Key findings

- Three patients with poststroke jaw-closing dystonia showed clinical improvement after botulinum toxin A treatment.
- Improvement was maintained for up to 10 years without adverse events.
- Poststroke oromandibular dystonia is under-recognized and requires further research for standardized treatment.

## Abstract

Poststroke oromandibular dystonia (OMD) is a rare and challenging to treat form of dystonia. Botulinum toxin A (BoNT‐A) is a standard treatment in other etiologies of OMD, but literature concerning a long‐term potential beneficial role in posthemorrhagic stroke OMD is scarce.

We present a case series of three patients with acute onset of multiple cranial nerve impairment and contralateral hemiparesis consequent to pontine hemorrhage. After a few months, all patients developed jaw‐closing OMD (JC‐OMD), conditioning a reduced mouth opening. Ultrasound‐guided BoNT‐A administration was started, and after 4 weeks, every patient showed clinical improvement. The results were maintained up to 10 years of follow‐up, and no adverse event was reported.

Poststroke OMD is an underestimated condition. Our cases provided data of safety and efficacy of BoNT‐A treatment up to 10 years of follow‐up. Further studies are warranted to establish etiopathological mechanisms and standardized treatments for poststroke JC‐OMD.