Objective: To measure whether neuromuscular electrical stimulation (NMES) increases jaw-opening distance and improves quality-of-life in jaw-closing dystonia patients.

Background: An index case with progressive supranuclear palsy and jaw-closing dystonia reported symptomatic benefit from NMES administered at an outside facility. NMES has previously been evaluated in treatment of dysphagia, but not in dystonia. The purpose of this pilot study is to determine whether NMES improves symptoms in jaw-closing dystonia, to develop methods and analytical approaches for a larger study, and to evaluate the safety and practicability of NMES in this population.

Method: 6 patients with jaw-closing dystonia (primary or secondary to a neurodegenerative disease or medication) will be enrolled. NMES will be applied for 20 minutes twice per week for a total of 16 sessions. Response to treatment will be measured using 2 methods. The first will evaluate degree of jaw-closing dystonia by determining the distance between the front teeth in the position of maximal voluntary jaw opening, measured using the quantity of tongue depressors the subject can fit between his or her teeth, i.e., tongue depressor quantity (TDQ). The second will evaluate the impact of jaw-closing dystonia on functional status using the oromandibular dystonia questionnaire (OMDQ-25). TDQ will be evaluated before and after each treatment session. OMDQ-25 will be evaluated at baseline and before each treatment session.

Results: D’Agostino-Pearson test will be utilized to see if TDQ and OMDQ-25 values are normally distributed in this population. We will test whether TDQ changes during each treatment session using paired t-test to compare pre- and post-treatment values for each patient. We will determine whether OMDQ-25 changes over the course of the study using repeated measures ANOVA. We will further use linear regression to investigate the relationship between each parameter and the number of treatment sessions.

Conclusion: NMES may be an effective symptomatic therapy for patients with jaw-closing dystonia. This study will determine whether symptomatic improvement occurs after each treatment session, whether the improvement is long-lasting and functionally relevant, and will provide critical data that allows planning for larger studies.

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MDS Abstracts - https://www.mdsabstracts.org/abstract/neuromuscular-electrical-stimulation-for-the-treatment-of-jaw-closing-dystonia/