Lack of efficacy of levetiracetam in oromandibular and cranial dystonia

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Oromandibular dystonia is a type of dystonia involving the mouth, jaw, and tongue that can result in repetitive opening and closing of the mouth, jaw deviation, and abnormal tongue movements. When the muscle contractions involve the eyes and upper face, the condition is referred to as cranial dystonia (previously termed Meige syndrome). Reports of the incidence of oromandibular and cranial dystonia are limited, but are estimated to be approximately 69 per one million persons, according to one epidemiology study.1
Treatments for oromandibular and cranial dystonia have been reported to have limited efficacy, and the most effective treatment to date is the injection of botulinum toxin (BoNT) which can produce temporary benefits but may cause side effects such as weakness in the injected or surrounding muscles, xerostomia, dysphagia, or dysarthria.2 Previous studies have shown that medications including anticholinergics, baclofen, clonazepam, and tetrabenazine are not efficacious for oromandibular or cranial dystonia, but there are some reports of beneficial effects of levetiracetam, a drug commonly used in the treatment of epilepsy.3 In these reported cases, improvement of dystonia was noted with the use of a moderate‐to‐high dose of levetiracetam (a total of 1500 mg‐3000 mg daily). As the evidence is limited, this study was conducted to assess the efficacy of levetiracetam in oromandibular and cranial dystonia.
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