Objective: To describe clinical features of oromandibular dystonia induced by Quran recitation.

Background: Task specific focal dystonias occurring exclusively during highly skilled motor tasks have been described previously in skilled musicians, dancers and golfers. However, oromandibular dystonia induced exclusively by reciting quranic verses have not been well described.

Methods: Six individuals with oromandibular dystonia induced exclusively by reciting quranic verses in non-native Arabic language during or outside prayers attending the neurology outpatients clinic at PPUKM, were evaluated by a movement disorder consultant.

Results: Six patients were included in this case series, with age ranging from 39 to 71 years. There were 3 males and 3 females. In all patients, their mother tongue was Malay and none spoke Arabic. There was no exposure to neuroleptics, dopamine blocking agents or history of dental surgery or implants in any of the patients. Five patients had oromandibular dystonia that was exclusively present while reciting Quranic verses in Arabic. One patient had mild oromandibular dystonia while speaking in the native language (Malay) which became worse on reciting the Quran. In one patient, the oromandibular dystonia particularly worsened when reciting Quran from memory, exaggerated further by more ‘difficult to recall’ verses. All patients had lingual dystonia in varying severity associated with jaw tightness (n=6), blepharospasm (n=2) and additional spasmodic dysphonia (n=2) on progressive recitation. Most patients had minimal improvement with combination of oral medications (clonazepam, trihexylphenidyl, baclofen). Three patients received botulinum toxin injections with minimal improvement.

Conclusions: Oromandibular dystonia occurring exclusively during Quran recitation expands the spectrum of task specifc focal dystonias described in the literature. As none of the patients were native Arabic speaking, it is possible that the extra mental and physical effort in attempting to recite the Quranic verses accurately could have contributed to abnormal plasticity regulation leading to the dystonia.

References: Odell, K., & K., U. (2012). Dystonia of the Oromandibular, Lingual and Laryngeal Areas. Dystonia – The Many Facets. doi:10.5772/28356.

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MDS Abstracts - https://www.mdsabstracts.org/abstract/unique-task-specific-oromandibular-dystonia-associated-with-quran-recitation/