Long-term effects of splint therapy in patients with posttraumatic stress disease (PTSD).

OBJECTIVES: The aim of a pilot study was to clarify the question of whether mouth opening restrictions in patients with PTSD by means of splint therapy (st) show long-term therapeutic effects in the case of functional disorders. MATERIAL AND METHODS: In 31 of 36 inpatients (soldiers, average age 37.1 ± 7.3 years, 26.7 ± 2.1 teeth) with confirmed posttraumatic stress disorder, chronic pain intensity > 6 (visual analogue scale 0 to 10), the mouth opening was determined, and the functional status (RDC-TMD) was recorded. All participants received a splint that was worn at night. A control of the therapeutic effect of the splint occurred after 6 weeks, 3, 6, and 12 months. RESULTS: The mouth opening initially had an average of 30.9 ± 6.5 mm (median 31 mm). The pain intensity (PI) was reported to be on average VAS 8.3 ± 0.9, the chronic degree of pain according to von Korff was 3.9 ± 03. Six weeks after the st (n = 31), the average mouth opening was 49.5 ± 6.3 mm (median 51.5). PI was given as VAS 2.3 ± 1.1 on average. After 3, 6, and 12 months, 24, 15, and 14 subjects could be interviewed regarding PI. Based on the last examination date of all subjects, the average PI was given as 1.1 ± 0.9 (median 1). CONCLUSION: The presented data show that the therapeutic short-term results achieved by means of a splint remain valid on the long term despite continued PTSD. CLINICAL RELEVANCE: The presented study shows that patients will benefit in the long term from a splint and remain symptom-free, even if this mental illness persists.

[Orofacial dysfunction and posttraumatic stress disorder : A context analysis of soldiers after military deployment]. / Orofaziale Funktionsstörung und posttraumatisches Belastungssyndrom : Eine Zusammenhangsanalyse bei Soldaten nach militärischen Einsätzen.

BACKGROUND: In studies on posttraumatic stress disorder (PTSD, ICD 10: F43.1) and in clinical observation, the high proportion of soldiers with painful craniomandibular dysfunction (CMD) is conspicuous. AIM: This study aimed to clarify if there is a connection between orofacial dysfunction, pain in this region, stress and PTSD. MATERIAL AND METHODS: A total of 36 inpatients (PTSD group) with specialist psychiatrically confirmed PTSD after up to 17 foreign deployments and 36 control subjects with 2-40 foreign deployments underwent a functional dental examination. All participants filled out a form for the gradation of chronic pain (GCP, degrees 0-4) as well as the depression, fear and stress scale (DFSS). RESULTS: Soldiers with PTSD had significantly worse orofacial functional diagnoses and higher pain scores, although on average they had less combat deployments (PTSD: maximum mouth opening 31.4 ± 8.0 mm vs. 57 ± 6 mm, GCP 3.5 ± 1.0 vs. 0.5 ± 0.5).The PTSD group showed a depression score of 14.9 ± 4.2 vs. the control group 1.4 ± 2.1, a fear score of 13.7 ± 3.9 vs. 1.0 ± 1.5 and a stress score of 16.1 ± 3.4 vs. 3.3 ± 2.9. CONCLUSION: The data from this pilot study show an obvious connection between PTSD and orofacial dysfunctions. Through further prospective studies it should be evaluated if there is a general vulnerability of those afflicted for pathological orofacial stress. This could be used for screening before combat deployment.

Early age of onset in fatal familial insomnia. Two novel cases and review of the literature.

Fatal familial insomnia (FFI) is a prion disease exhibiting the PRNP D178N/129M genotype. Features of this autosomal dominant illness are progressive insomnia, dysautonomia, myoclonus, cognitive decline and motor signs associated with thalamic nerve cell loss and gliosis. In contrast to the new variant of Creutzfeldt-Jakob disease (vCJD) the onset of FFI is in middle to late adulthood. We report two male patients who belong to a large German FFI kindred. They were examined clinically, and postmortem neuropathological examination was carried out in collaboration with the German reference centre for prion disease. Additionally, the prion protein gene (PRNP) was analysed. To identify further patients with disease onset under 30 years of age a comprehensive literature review was carried out. Two male patients presented with typical symptoms of FFI at the age of 23 and 24 years. In their kindred, the age of onset has never before been under 44 years of age. Our literature review identified five additional early onset cases who died at age 21 to 25 years. In all 22 reviewed FFI families the median manifestation age was 49.5 years. Although phenotypic variability of FFI is common, age of onset under 30 years has been considered to be a hallmark of vCJD with a mean manifestation at 27 years of age. Our findings underline that in addition to vCJD, FFI must be considered in cases of young-onset prion disease. This has considerable impact on clinical management and genetic counselling.