Cerebral palsy and bruxism: Effects of botulinum toxin injections-A randomized controlled trial.

Objective: Cerebral palsy (CP) includes disturbances in muscular control caused by perinatal brain injury. Masticatory muscle involvement hampers functions such as chewing and talking. Bruxism and temporomandibular disorders are overrepresented. Neuromuscular blocks with botulinum toxin type A (BTX-A) may alleviate problems due to muscular hyperactivity. The aim was to evaluate masticatory muscle BTX-A injections in subjects with CP and bruxism. Methods: A prospective, parallel, randomized, placebo-controlled, and double-blind trial in 12 patients with CP was performed. End points were alterations in objective and subjective oral capacities after two BTX-A or corresponding placebo injections. Matched, healthy references were also evaluated. Results: The reference group demonstrated stronger and more efficient oral functions compared with the CP group. Subjective and objective oral capacities appeared to vary considerably between CP patients and also over time in this patient group and were poorly correlated. No significant effect of BTX-A compared with placebo on outcome variables was observed at group level, but continued treatment with BTX-A was requested by the majority of the patients. Conclusion: The evidence is unable to support the use of BTX-A for the treatment of affected masticatory muscles in CP, but the findings are inconclusive in certain respects. Larger, more homogeneous groups of CP patients need to be evaluated in future trials.

A randomised, open-label, crossover study of the dopamine agonist, pramipexole, in patients with sleep bruxism.

Sleep bruxism bears several similarities to restless legs syndrome, and a link to changes in central dopamine activity has been considered in both conditions. The dopamine agonist pramipexole is currently indicated for the symptomatic treatment of restless legs. The effect of pramipexole on sleep bruxism was investigated in subjects with 'probable bruxism' recruited at the Orofacial Pain Clinic. Thirteen patients underwent polysomnographic recordings, including bilateral masseter electromyographic activity. Following habituation to the recording equipment, a baseline registration was used to confirm bruxism [total episodes per hour, mean 11.3 (6.3)]. Following randomisation, subjects received no treatment or pramipexole titrated from 0.09 to 0.54 mg, o.d., for 3 weeks according to a crossover procedure. A polysomnographic-electromyographic registration was performed at the end of each period. Pramipexole was associated with more frequent awakenings and a reduction in rapid eye movement sleep (both P ≤ 0.02). Sleep apnea decreased marginally after pramipexole (apnea-hypopnea index 17.1 compared with control 21.5, P ≤ 0.05). The number of bruxism episodes, phasic, tonic and mixed per hour, remained unchanged after pramipexole [total episodes per hour 12.7 (8.5) and 9.8 (5.2) during pramipexole and control conditions, respectively]. It is concluded, from this pilot study, that sleep bruxism is not affected by the dopaminergic agent, pramipexole.

No effect of glucosamine sulfate on osteoarthritis in the temporomandibular joints--a randomized, controlled, short-term study.

OBJECTIVE: The aim of this study was to evaluate the clinical effects of oral glucosamine sulfate, compared with placebo, on osteoarthritis in the temporomandibular joints (TMJs). STUDY DESIGN: Fifty-nine patients, consecutive referrals fulfilling the research diagnostic criteria for temporomandibular disorder for TMJ osteoarthritis, confirmed roentgenographically, were randomized to the daily intake of 1,200 mg glucosamine sulfate or identical placebo capsules in this double-blind trial. Pain on visual and verbal rating scales and opening capacity were registered before and after 6 weeks of medication. RESULTS: The signs and symptoms were similar in the groups initially and they were ameliorated over time. No differences in improvement between groups after treatment were indicated. Eight patients in the glucosamine group and 2 in the placebo group stopped the medication prematurely. Gastrointestinal side effects were reported by a total of 10 and 3 patients, respectively. CONCLUSIONS: Oral glucosamine sulfate was not superior to placebo in reducing signs and symptoms of osteoarthritis in the TMJs in this short-term trial.