Related Experiment Videos
Stroke-induced trismus in a pediatric patient: long-term resolution with botulinum toxin A
Kathleen S Spillane1, Jean E Shelton, Michael F Hasty
1Department of Pediatric Physical Medicine and Rehabilitation, Children's Hospital of the King's Daughters, Eastern Virginia Medical School, Norfolk, Virginia 23507, USA.
Insights
Botulinum toxin A injections effectively treated prolonged trismus in a pediatric stroke patient. Repeated treatments improved jaw opening, aiding speech and eating.
Area of Science:
- Neurology
- Pediatric Neurology
Background:
- Stroke can cause neurological deficits, including trismus (jaw spasm).
- Trismus management in pediatric stroke survivors can be challenging.
Observation:
- A 9.5-year-old boy with posterior fossa hemorrhage developed severe, refractory trismus.
- Initial botulinum toxin A injections showed minimal improvement.
Findings:
- A staged, multi-muscle botulinum toxin A treatment protocol led to sustained improvement.
- Significant increases in interincisal distance were achieved, enhancing function.
Implications:
- Botulinum toxin A is a viable therapeutic option for persistent trismus post-stroke in children.
- Aggressive, targeted injections may be necessary for optimal outcomes.
Abstract:
We present a case of prolonged resolution of stroke-induced trismus after botulinum toxin A treatment in a 9 1/2-yr-old boy. The patient had an idiopathic right posterior fossa hemorrhage with resultant spastic quadriparesis, ataxia, dysarthria, and dysphagia. He developed right-sided trismus with only fair response to stretch. Several months after discharge, the patient had worsening trismus with an interincisal distance of only 0.4-0.7 cm and difficulty with oral hygiene and eating. The patient was treated with botulinum toxin A to the masseter muscles with minimal response. Four months later, he received botulinum toxin A to the bilateral masseter and temporalis muscles and to the right medial and lateral pterygoid muscles, with more improvement. His third and last botulinum toxin A treatment was to the bilateral masseter, temporalis, lateral, and medial pterygoid muscles in larger doses. He had an excellent response, maintaining an interincisal distance of 2.5 cm 1 yr later, with significant improvement in speaking and chewing.