Tongue protrusion dystonia: treatment with botulinum toxin

We report the treatment experience in a series of patients with involuntary tongue protrusion resulting from oromandibular dystonia (OMD) or Meige's syndrome. A retrospective analysis of clinical findings and results of treatment was conducted on patients treated at Vanderbilt University Medical Center between 1989 and 1995. After unsuccessful treatment with conventional oral medications, nine patients having involuntary tongue protrusion resulting from OMD or Meige's syndrome were treated with botulinum toxin type A (BTX-A) injected into the genioglossus muscle at four sites via a submandibular approach. A marked reduction in tongue protrusion was achieved in six patients (67%). Of 35 consecutive injections, 83% were successful at reducing tongue protrusion. Mild dysphagia complicated 14% of the injections. The average dose injected was 34 (+/- 3) units producing a 15 (+/- 2) week average duration of effect. Injection of the genioglossus with BTX-A may prove to be a valid treatment option for involuntary tongue protrusion related to OMD or Meige's syndrome. A double-blind, placebo-controlled trial is needed to better define efficacy and adverse events.