Treatment of oromandibular dystonia with botulinum toxin A improves apnea in a teenager with quadriplegic cerebral palsy: A case report.
Jeremy Roberts, Amy Tenaglia, Elisabeth Bellissimo and 1 others
PMID 37522227WHAT IT FOUND
In one teenager with cerebral palsy, botulinum toxin injections into jaw muscles reduced obstructive sleep apnea episodes from 3-7 nightly to near zero.
This allowed a decrease in CPAP pressure from 30 to 5 cmH2O and postponed surgery. This is a single case, not evidence of efficacy.
Key findings
01Injections into the lateral pterygoid muscles alone, while masseter and temporalis effects were still present, led to a significant decrease in apneic events.
02Subsequent injections into all three muscles of mastication (lateral pterygoids, temporalis, and masseter) resulted in an average of one apneic episode nightly for two months.
03Over the treatment period, the patient's CPAP setting was decreased from 30 cmH2O to 5 cmH2O and surgical intervention for jaw structure was postponed.
STILL TO COME
How it was doneWhat they foundWhat it means for PTsWhat it means for OTsWhat it means for SLPs
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What it does not show
This is a single case report, so the results cannot be generalized to other patients. The improvement in OSA was not the primary expected outcome, so no formal sleep studies were conducted before and after the specific injections to confirm the physiological change. The patient received multiple interventions over time, including changes in which muscles were injected and ongoing CPAP use, making it difficult to isolate the exact cause of the improvement. The authors note that the greatest improvement occurred when both mouth opening and closing muscles were treated, suggesting the effect may depend on complex muscle coordination rather than a single target.
Declared interests
No specific funding sources or conflicts of interest are declared in the provided text.
The easy way to misread this
Do not interpret this single case as evidence that botulinum toxin is a proven treatment for obstructive sleep apnea in cerebral palsy. The lack of pre-registered outcomes, formal sleep studies, and a control group means this describes one person's response, not a generalizable therapeutic effect.