Botulinum toxin type A combined with cervical spine manual therapy for masseteric hypertrophy in a patient with Alzheimer-type dementia: a case report

Abstract

Objective: The purpose of this case study is to present the findings of combining botulinum toxin type A (BoNT-A) and cervical spine manual therapy to address masseter muscle spasticity in a patient with Alzheimer-type dementia. Case Report: A 78-year-old woman with bilateral spasticity of the masseteric regions for 2 years was referred for physiotherapy. She had trismus and bruxism, and could neither close nor open her mouth normally; thus, she was unable to be fed orally in a normal manner. Intervention and Outcome: The patient underwent combined treatment with BoNT-A and cervical spine manual therapy. A medical physician (neurologist) performed the BoNT-A injections into 2 points at the center of the lower third of the masseter muscle. A physical therapist performed manual therapy interventions targeted at the cervical spine. Manual therapy started the day after the BoNT-A injection and continued for 5 sessions per week for a total period of 2 weeks. Clinical outcomes were measured including spasticity (Modified Ashworth Scale), functionality (Barthel Index), and jaw opening. Outcomes were conducted at baseline, 2 weeks after treatment, and at 2-month follow-up session after finishing the treatment. The patient improved in all of the outcomes at the end of treatment, and these Journal of Chiropractic Medicine (2012) 11, 280-285 results were maintained during the follow-up. After treatment, the patient was able to feed with minimal caregiver dependency because oral feeding was possible. Conclusion:The patient in this study responded positively to a combination of BoNT-A and manual therapy, resulting in decreased masseter muscles spasticity and improved trismus and bruxism.

Effectiveness of Global Postural Re-education in Patients With Chronic Nonspecific Neck Pain: Randomized Controlled Trial

“…Then, passive mobilization was applied to the cervical spine using Maitland's technique for posterior to anterior accessory movements by applying the PT's thumbs to the spinous process with a rhythmic gentle pressure. 32,33 Only slow, grade II movements were performed from C0-C1 to C7-T1 for approximately one minute for each cervical level. Therapeutic massage was applied to neck and 10 shoulders areas as final technique for approximately fifteen minutes using almond oil.…”

Bruxismus im Zusammenhang mit neurokognitiven Störungen

“…In Fallberichten wurden erfolgreiche Bruxismusbehandlungen mit lokalen Injektionen von Botulinumtoxin Typ A beschrieben (Mathew et al 2017;Villafañe et al 2012). Botulinumtoxin hemmt die Ausschüttung von Acetylcholin und damit die Aktivierung der Muskelkontraktion und setzt so den Muskeltonus herab.…”