Task-Specific Lingual Dystonia During Japanese Religious Services.

[INTRODUCTION] Lingual dystonia is a subtype of oromandibular dystonia characterized by involuntary contractions of the tongue muscles, often provoked by speaking or eating.

[METHODS] This study reports six Japanese cases (four female and two male, mean age at onset of 49.5 years) with task-specific lingual dystonia during praying. In the early phase, all patients experienced lingual protrusion exclusively during Japanese religious services. When the patients start speaking, the tongues protrude forward, making it difficult to pronounce words. The patients were treated with multimodal treatment, including muscle afferent block (MAB) therapy comprising local anesthetic injection, botulinum toxin (onabotulinumtoxinA) injection, and a sensory trick splint.

[RESULTS] MAB therapy was conducted in five patients (mean time: 5.8), and botulinum toxin injection was administered in four patients (mean time: 8). The injected muscles were the genioglossal muscles and, in one case, the lateral pterygoid muscle. Sensory trick splints were inserted in three patients. After the multimodal therapy, the patients were able to pronounce words smoothly and clearly. Oromandibular Dystonia Rating Scale scores improved significantly (P<0.005) from baseline (187 points) to endpoint (47 points) with a mean follow-up of 4.7 years.

[CONCLUSION] Although this entity is rare, medical and dental professionals should be aware of this peculiar symptom. Multimodal therapy is required to ensure effective treatment of praying-induced lingual dystonia.