[Botulinum toxin treatment of neurogenic dislocation of the temporomandibular joint]. / Botulinumtoxinbehandlung der neurogenen Kiefergelenkluxation.

Botulinum toxin leads to paresis of the skeletal muscle lasting 2-4 months via an inhibition of acetylcholine release at the neuromuscular junction. Since 1995, botulinum toxin injections have been used in the treatment of recurrent dislocation of the temporomandibular joint (TMJ). The chemical denervation of the external pterygoid muscle restricts the angle of mouth opening, thus helping to prevent dislocation. TMJ dislocations that occur as a result of increased tone in the protracted masticatory muscles were recently defined as neurogenic dislocations of the TMJ. We conducted a clinical study to investigate the efficacy of botulinum toxin injections into the external pterygoid muscle in five patients with recurrent neurogenic dislocations of the TMJ. In the 3 months prior to the first treatment, the patients had suffered a total of 19 dislocations. In the 3-month period following the initial treatment, only one woman experienced a dislocation. We performed the treatment a total of 25 times. Five dislocations occurred during the 6- to 36-month observation period. In the meantime, two patients remain recurrence-free 1 year after receiving treatment. All the patients had a restricted ability to open their mouths as a side effect of the weakening of the external pterygoid muscle that was completely reversible over the course of 3-4 months. All other side effects were equally well-tolerated by the patients and fully reversible after 3 weeks at the most. In the two patients who remain recurrence-free without any further treatment, the increased tone of the muscles serving the jaw normalised spontaneously over the course of the underlying neurological disease. Our results show that, in the treatment of recurrent neurogenic dislocations of the TMJ, botulinum toxin injections represent a therapeutic alternative that has few side effects.

[Botulinum toxin type A in the treatment of neurogenic dislocation of the temporomandibular joint]. / Botulinumtoxinbehandlung der neurogenen Kiefergelenkluxation.

Botulinum toxin leads to paresis of the skeletal muscle lasting 2-4 months via an inhibition of acetylcholine release at the neuromuscular junction. Since 1995, botulinum toxin injections have been used in the treatment of recurrent dislocation of the temporomandibular joint (TMJ). The chemical denervation of the external pterygoid muscle restricts the angle of mouth opening, thus helping to prevent dislocation. TMJ dislocations that occur as a result of increased tone in the protracted masticatory muscles were recently defined as neurogenic dislocations of the TMJ. We conducted a clinical study to investigate the efficacy of botulinum toxin injections into the external pterygoid muscle in five patients with recurrent neurogenic dislocations of the TMJ. In the 3 months prior to the first treatment, the patients had suffered a total of 19 dislocations. In the 3-month period following the initial treatment, only one woman experienced a dislocation. We performed the treatment a total of 25 times. Five dislocations occurred during the 6- to 36-month observation period. In the meantime, two patients remain recurrence-free 1 year after receiving treatment. All the patients had a restricted ability to open their mouths as a side effect of the weakening of the external pterygoid muscle that was completely reversible over the course of 3-4 months. All other side effects were equally well-tolerated by the patients and fully reversible after 3 weeks at the most. In the two patients who remain recurrence-free without any further treatment, the increased tone of the muscles serving the jaw normalised spontaneously over the course of the underlying neurological disease. Our results show that, in the treatment of recurrent neurogenic dislocations of the TMJ, botulinum toxin injections represent a therapeutic alternative that has few side effects.

[Neurogenic temporomandibular joint dislocation. Definition and therapy with botulinum toxin]. / Neurogene Kiefergelenkluxation. Definition und Therapie mit Botulinumtoxin.

Dislocation of the temporomandibular joint results from trauma, articulation disorders and changes in the equilibrium of the masticatory muscles. Previous classifications were mostly oriented on the interrelationships between the anatomical positions of the dislocated articular surfaces, like luxation, subluxation and discuss luxation. Etiologically, a distinction is made between traumatic and non-traumatic dislocation. Dislocation of the temporomandibular joint is described as a complication of a number of neurological diseases. We report on a patient who suffered recurrent dislocations of the temporomandibular joint as a complication of multiple sclerosis and whose luxations were successfully treated with botulinum toxin, thus warranting the introduction of the term "neurogenic dislocation of the temporomandibular joint".

Treatment of recurrent dislocation of the temporomandibular joint with type A botulinum toxin.

A case is reported of a 56-year-old woman who suffered from recurrent dislocations of the temporomandibular joint (TMJ) secondary to an exacerbated tetraspastic syndrome of multiple sclerosis. Following chemical denervation of the masseter and pterygoid muscles with injections of type A botulinum toxin, no further dislocations occurred for periods of up to four months. The treatment has been repeated five times. Some of the indications and possible adverse reactions to this therapy are discussed and comparisons made with other, conventional methods for managing recurrent dislocation of the TMJ.

[Auditory evoked brain stem potentials, visual pattern evoked and somatosensory evoked potentials in transient ischemic attacks (TIA)]. / Auditorisch evozierte Hirnstammpotentiale, visuell musterevozierte und somatosensibel evozierte Potentiale bei transitorisch ischämischen Attacken (TIA).

Auditory-evoked brainstem potentials, visual pattern-evoked and somatosensory-evoked potentials in transitory ischemic attacks (TIA). Pathological findings in patients suffering from transitory ischemic attacks by means of using neuroradiological methods (CCT included) are a rare condition. The combination of visual checkerboard-evoked potentials (VEP), auditory brainstem-evoked (AEP) and somatosensory-evoked potentials (SSEP) can detect functional lesions in cerebral regions with different blood supply but without diagnostic risk. A delay of peak III of the AEP is possibly of specific value with regard to brainstem lesion caused by TIA in our patients.

[Visual evoked potentials in cerebrovascular disorders. Method and results]. / Visuell evozierte potentiale bei zerebralem gefässprozess methodik und ergebnisse.

Investigation of visual evoked potentials (VEP) by means of checkerboard inversion gives values with good reproducibility and low standard deviation for the latencies and amplitudes of VEP. In patients with scanty symptoms of cerebrovascular disease and without visual field defects, we found either differences of VEP amplitudes from side to another of over 25% (in relation to the larger value) or very small absolute values of the amplitudes (smaller than 3 mu V) as pathological values compared to control subjects. The latencies were normal. The method of investigation described helps towards objective analysis of functional disturbances in patients with cerebrovascular diseases.

[Thrombosis of A. cer media in Werlhof's disease (author's transl)]. / Mediaverschluss bei Morbus Werlhof

Apoplectiform incidents, particularly in young patients, can be an exceptional problem for neurologists and internists, even when every technical aid for diagnosis is available. This paper is intended to point out that even in a basic disease like Werlhof's disease, which is accompanied by an increased hemorrhagic tendency, several additive or potentiating unfavorable factors can produce a thrombosis in the region of a cerebral vessel and for this reason they should be included in the differential diagnostic considerations.