Objective: The aim of our study was to perform a literature review about the botulinum toxin types, their dosage and muscle target in the treatment of lingual protrusion dystonia.

Background: Lingual dystonia is a rare form of focal dystonia. [1] It can be primary or secondary and it can manifest itself as tongue thrusting, drooling, twitching or, most commonly, protruding. [2] Botulinum toxin (BT) has long been used as a first-line treatment in the management of dystonia. [3]

Method: A search was made in 3 databases (Scopus, PubMed and Cochrane/Embase) using the descriptors “BOTULINUM TOXIN” AND “LINGUAL DYSTONIA” OR “TONGUE DYSTONIA” on February 2023. The exclusion criteria were: review articles, preclinical results, comments to other texts previously published, articles which presented other treatments that not BT or other dystonia that not lingual protrusion, published in languages other than English, the ones that did not cite the muscle targets, the BT dosis or the toxin used.

Results: Two hundred five articles were found, of which 64 were repeated (since they were found in more than one database). 130 articles were excluded after being read. The remaining 11 papers were included in our study. Eight studies were conducted injecting 22 patients with onabotulinum toxin type A (OBNTA). The mean dosage was 21.1 (5-60; SD 16.1) Units (U). Sixteen patients considered the results excellent or satisfactory; three participants achieved mild results and other three classified the improvement as inexisting. Two studies were conducted injecting abobotulinum toxin type A (AboBNTA) with a mean dosage of 77.5 U (30-125; SD 67.2). Both of the patients considered the results obtained satisfactory. One study used incobotulinum toxin type A (IncoBNTA) with a 30 U dose. The result was considered satisfactory. The chosen muscle was the genyoglossus, either with one single injection at midpoint or up to 4 at the anterior and posterior portions of it. The researchers diluted the toxins in saline solution and injected it using 25 to 30 gauges needles.

Conclusion: Lingual protrusion dystonia has a good response to botulinum toxin type A injections in the genioglossus muscle. The most commonly used toxin is the onabotulinum toxin type A. It requires the smallest dosis and has an overall satisfactory result. Abobotulinum toxin type A and incobotulinum toxin type A seems to also be possible choices in the lingual dystonia management.

References: 1. Albanese A, Bhatia K, Bressman SB, Delong MR, Fahn S, Fung VS, Hallett M, Jankovic J, Jinnah HA, Klein C, Lang AE, Mink JW, Teller JK. Phenomenology and classification of dystonia: a consensus update. Mov Disord. 2013 Jun 15;28(7):863-73. doi: 10.1002/mds.25475. Epub 2013 May 6. PMID: 23649720; PMCID: PMC3729880.
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11. Cores-Bartolomé C, Paz-González JM, García-Antelo MJ, Santos-García D. Isolated speech-induced lingual dystonia successfully treated with botulinum neurotoxin. Neurologia (Engl Ed). 2022 May;37(4):306-308. doi: 10.1016/j.nrleng.2021.05.004. PMID: 35595406.
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