■局灶性任务特异性肌张力障碍是孤立的局灶性肌张力障碍的一种形式,在执行特定的熟练运动任务时发生。文献中很少报道与古兰经经文背诵相关的口腔下颌肌张力障碍(OMD)的发生,非母语阿拉伯语患者。这个病例系列描述了一种罕见的局灶性任务特定的肌张力障碍,这种肌张力障碍仅通过在讲阿拉伯语的患者中背诵古兰经而发生。从未被报道过,据我们所知.
■在这种情况下,我们确定了5例新发OMD患者,这些患者完全是通过背诵《古兰经》诱发的.病例在IbnSina医院的运动障碍门诊进行了评估;科威特主要的三级神经病学中心,2015年至2023年。
■5例(3名男性,在这项研究中确定了2名女性)。症状发作的平均年龄为52.3±4.1岁,而诊断前症状的中位持续时间为3年。所有患者都是讲阿拉伯语的人,以前没有其他类型的肌张力障碍病史。没有可识别的危险因素,包括暴露于多巴胺阻断剂或抗精神病药,或口腔或牙科手术史。患者接受了全面的临床,实验室,和放射学评估。所有患者都有不同形式和严重程度的OMD肌张力障碍,而两名患者在进行性背诵时出现了额外的痉挛性发声困难/眼睑痉挛。大多数患者在口服药物和言语治疗的组合下的改善最小。四名患者接受了肉毒杆菌毒素注射,效果更好。
■尝试背诵古兰经经文的精神和身体压力可能导致OMD的发展。此外,对下巴肌肉的需求增加,嘴唇,背诵时的舌头会引发肌张力障碍症状。
■仅在古兰经背诵时OMD是一种罕见的现象,并扩展了文献中描述的特定任务的局灶性肌张力障碍的范围。发现这对患者来说是痛苦的,也是治疗的挑战。及时识别可以最大限度地减少不必要的测试和程序,并促进早期治疗。
Focal task-specific dystonia is a form of isolated focal dystonia that occurs during the performance of a specific skilled motor task. The occurrence of oromandibular dystonia (OMD) specifically in association with the recitation of Quranic verses have been rarely reported in the literature, in non-native Arabic-speaking patients. This case series describe a rare type of focal task-specific dystonia that occurs exclusively by reciting Quran in native Arabic-speaking patients, which has never been reported, to the best of our knowledge.
In this case series, we identified five patients with new-onset OMD that was exclusively induced by reciting Quran. Cases were evaluated in our Movement Disorders outpatient clinic at Ibn Sina hospital; the main tertiary neurology center in Kuwait, between 2015 and 2023.
Five cases (3 males, 2 females) were identified in this study. Mean age of onset of the symptoms was 52.3 ± 4.1 years, while the median duration of the symptoms prior to diagnosis was 3 years. All patients were native Arab-speaking, with no previous history of other types of dystonia. No identifiable risk factors could be obtained including exposure to dopamine blocking agents or antipsychotics, or history of oral or dental surgery. Patients underwent a full clinical, laboratory, and radiological evaluation. All patients had OMD dystonia in varying forms and severity, while two patients had additional spasmodic dysphonia/ blepharospasm on progressive recitation. Most patients had minimal improvement with combination of oral medications and speech therapy. Four patients received botulinum toxin injections with better results.
The mental and physical stress in attempting to recite the Quranic verses could have contributed to the development of OMD. Moreover, the increased demand on the muscles of the jaw, lips, and tongue during recitation can trigger the dystonic symptoms.
OMD exclusively during Quran recitation is a rare phenomenon, and expands the spectrum of task-specific focal dystonia described in the literature. It was found to be distressing to the patients and a challenge to treat. Prompt recognition could minimize unnecessary testing and procedures, and facilitate earlier treatment.