We Must Talk about Sex and Focal Dystonia

Rafee, Shameer; O’Riordan, Sean; Reilly, Richard B.; Hutchinson, Michael

doi:10.1002/mds.28454

Cited by 11 publications

(9 citation statements)

References 38 publications

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“…Interestingly, while male to female ratio was found to be equal in the age group of 10–30 s, a female predominance was observed over the age of 40 years. Dystonia is often found in young men but increases in women with aging ( 10 ). The D2 receptor density and binding potential in the striatum reduce with age; moreover, a lower affinity of the D2 receptors in women with a greater decline in aging than in men has been reported ( 11 ).…”

Section: Discussionmentioning

confidence: 99%

Case series of drug-induced open bite: Extrapyramidal symptoms related to psychotropic medications

Watanabe

Takao

et al. 2023

Front. Psychiatry

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IntroductionDrug-induced open bite is one of the extrapyramidal symptoms with abnormal tonus of muscles and is rarely recognized in dentistry. This is a retrospective case study to investigate clinical characteristics including detailed complaints in patients with drug-induced open bite.MethodsOf the outpatients who first visited the psychosomatic dental clinic at the Tokyo Medical and Dental University Hospital between September 2013 and September 2022, the patients diagnosed with drug-induced open bite were involved in this study. The clinical characteristics including sex, age, detailed complaints, duration of illness, abnormal findings, psychotropic medications, and other medications that were taken at the first examination, psychiatric comorbidities, the duration of psychiatric diseases, and other medical histories were collected retrospectively by reviewing their medical chart.ResultsDrug-induced open bite was found in 11 patients [women: 7, men: 4, median of age: 49 (36.5, 53) years old]. Difficulty in eating especially chewing was the major complaint (9/11, 81.6%) with the duration of illness as 48.0 (16.5, 66) months. Various degrees of open bite were observed. While some showed no occlusal contact on frontal teeth, some showed occlusal contact only on the second molars; moreover, the jaw showed a horizontal slide in a few patients. Three cases could be followed up for prognosis; while in one case the drug-induced open bite improved with 6 months of follow-up, two cases did not improve, and one showed extrusion of molars. All of them had psychiatric comorbidities with the most common diagnosis being schizophrenia (n = 5) and depression (n = 5) followed by insomnia (n = 1) and autism spectrum disorder (n = 1) including duplicated diagnosis. Nine patients (81.6%) had been undergoing treatment with antipsychotics of which three patients were also taking antidepressants.DiscussionAlthough a drug-induced open bite is a rare symptom, prudent medical interviews about symptoms, psychiatric comorbidities, and psychotropic medication history besides oral assessment are necessary to provide a precise diagnosis and appropriate management in collaboration between dentists and psychiatrists.

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Section: Discussionmentioning

confidence: 99%

Case series of drug-induced open bite: Extrapyramidal symptoms related to psychotropic medications

Watanabe

Takao

et al. 2023

Front. Psychiatry

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“…There could be genes on the X-chromosome that make females more vulnerable, or there could be genes on the Y-chromosome that protect males. It is interesting to note that there is a significant female predominance for most other types isolated dystonia as well [67 ▪ ].…”

Section: How Can a Single Gene Cause Multiple Different Phenotypes?mentioning

confidence: 99%

“…There could be genes on the Xchromosome that make females more vulnerable, or there could be genes on the Y-chromosome that protect males. It is interesting to note that there is a significant female predominance for most other types isolated dystonia as well [67 ]. Dystonia genes interact with environmental influences, providing a third mechanism that might account for clinical heterogeneity associated with a single dystonia gene.…”

Section: How Can a Single Gene Cause Multiple Different Phenotypes?mentioning

confidence: 99%

The apparent paradox of phenotypic diversity and shared mechanisms across dystonia syndromes

Fonzo

Albanese

Jinnah

2022

Current Opinion in Neurology

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Purpose of reviewWe describe here how such mechanisms shared by different genetic forms can give rise to motor performance dysfunctions with a clinical aspect of dystonia.Recent findingsThe continuing discoveries of genetic causes for dystonia syndromes are transforming our view of these disorders. They share unexpectedly common underlying mechanisms, including dysregulation in neurotransmitter signaling, gene transcription, and quality control machinery. The field has further expanded to include forms recently associated with endolysosomal dysfunction.SummaryThe discovery of biological pathways shared between different monogenic dystonias is an important conceptual advance in the understanding of the underlying mechanisms, with a significant impact on the pathophysiological understanding of clinical phenomenology. The functional relationship between dystonia genes could revolutionize current dystonia classification systems, classifying patients with different monogenic forms based on common pathways. The most promising effect of these advances is on future mechanism-based therapeutic approaches.

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“…A recent paper of Raffee and associates presents the evidence of sex being single and the most important biological variable in relation to disease penetrance and expression in adult-onset idiopathic isolated focal dystonia [18]. CD is more prevalent in women, but men's mean age of onset is 4 years earlier than women, while women with a history of anxiety/depression, at any time, had an earlier onset of motor symptoms when compared with women with no mood disorder [19].…”

Section: Introductionmentioning

confidence: 99%

Psychiatric Symptoms in Women with Focal Cervical Dystonia - Exploring New Pathophysiological Pathways

Kuric

Popović

Tomić

et al. 2023

Arch. Psychiatry Res.

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So far there is not much research considering female sex as a risk factor for developing focal cervical dystonia and concomitant psychiatric symptoms such as anxiety. New research proposes ideas of CD baseline pathophysiology targeting neurobiological mechanisms of gamma aminobutyric acid GABAergic function underlying sexual dimorphism and psychiatric symptoms as an intrinsic factor of the disease itself. Our research examines the connection between motor and non-motor symptoms in female patients suffering from focal cervical dystonia and their response to treatment, cit- ing the available literature and hypothesising whether it can be linked to previously described alterations in GABA levels.

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We Must Talk about Sex and Focal Dystonia

Cited by 11 publications

References 38 publications

Case series of drug-induced open bite: Extrapyramidal symptoms related to psychotropic medications

Case series of drug-induced open bite: Extrapyramidal symptoms related to psychotropic medications

The apparent paradox of phenotypic diversity and shared mechanisms across dystonia syndromes

Psychiatric Symptoms in Women with Focal Cervical Dystonia - Exploring New Pathophysiological Pathways

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