Bruxism in patients of moderate to severe traumatic brain injury: Management results suggesting an etiological mechanism

 

PDF Download Buy Article Permissions and Reprints

Abstract

Introduction

Bruxism is an unusual event among patients of altered sensorium after brain injury. Occasionally the bruxism may be so severe as to cause harm to the patients and make nursing difficult. This study presents such cases that were managed by the author. A possible explanation for post-brain injury bruxism is suggested.

Material and method

Twelve patients of brain injury following trauma who were observed to have bruxism were included in the study. The clinical presentation and the response to intervention were studied. Patients less then 16 years were managed with benzodiazepines only. Patients more than 16 years of age were managed with benzodiazepines and pramipexole was administered in addition to benzodiazepines in 5 patients.

Observation

Of the 12 patients 3 subjects were classified as severe brain injury. Nine patients had suffered moderate grade brain injury. 3 (25%) patients were children and the mean age of the rest 9 (75%) patients was 40 years. The children were managed with benzodiazepines. The median time of onset of bruxism from the time of injury was 5.25 days with range of 2 days–12 days. Pramipexole, a dopamine agonist, was useful in management of severe bruxism with a latency period of 2 days. All patients except one recovered within 7 days after starting the treatment.

Conclusion

Bruxism is distressing to a patient-in-recovery following brain injury and cause significant inconvenience to the nursing staff. Effective treatment included the use of benzodiazepines and pramipexole. Pramipexole, a dopamine receptor agonist, should be considered an option for pharmacological management of bruxism after brain trauma. If central pattern generators (CPG) are involved in some of the disabilities of moderate to severe brain injuries like bruxism, there is a rationale for considering a larger study for the use of dopamine receptor agonist in such patients.

• References

• 1 Lobbezoo F., Ahlberg J., Glaros A.G., Kato T., Kayano K.. Bruxism defined and graded: an international consensus. J Oral Rehabil 2013; 40: 2-4
  CrossrefPubMedGoogle Scholar
• 2 Pollack I.A., Cwik V.. Bruxism following cerebellar hemorrhage. Neurology 1989; 39 (09) 1262
  CrossrefPubMedGoogle Scholar
• 3 Pratap-Chand P., Gourie Devi M.. Bruxism: its significance in coma. Clin Neurol Neurosurg 1985; 87 (02) 113-117
  CrossrefPubMedGoogle Scholar
• 4 FitzGerald P.M., Jankovic J., Percy A.K.. Rett syndrome and associated movement disorder. Mov Disord 1990; 05 (03) 195-202
  CrossrefPubMedGoogle Scholar
• 5 Meletti S., Cantalupo G., Volpi L., Rubboli G., Magaudda A., Tassinari C.A.. Rhythmic teeth grinding induced by temporal lobe seizures. Neurology 2004; , Jun 22 62 (12) 2306-2309
  CrossrefPubMedGoogle Scholar
• 6 Lavigne G.J., Kato T., Kolta A.. Neurobiological mechanism involved in sleep bruxism. Clin Rev Oral Biol Med 2003; 14 (01) 30-46
  PubMedGoogle Scholar
• 7 Lund J.P., Drew T., Rossignol S.. A study of the jaw reflexes of the awake cat during mastication and locomotion. Brain Behav Evol 1984; a 25: 146-156
  CrossrefPubMedGoogle Scholar
• 8 Lund J.P., Kolta A., Westberg K.G., Scott G.. Brainstem mechanism underlying feeding behaviours. Curr Opin Neurobiol 1998; 08: 718-724
  CrossrefPubMedGoogle Scholar
• 9 Nakamura Y., Katakura N., Nakajima M.. Generation of rhythmical food ingestive activities of the trigeminal, facial and hypoglossal motorneurons in in vitro CNS preparations isolated from rat and mice. J Med Dent Sci 1999; 46: 63-73
  PubMedGoogle Scholar
• 10 Lund J.P.. Mastication and its control by the brainstem. Crit Rev Oral Biol Med 1991; 02: 33-64
  PubMedGoogle Scholar
• 11 Sawczuk A., Moiser K.M.. Neural control of tongue movement with respect to respiration and swallowing. Crit Rev Oral Biol Med 2001; 12: 18-37
  CrossrefPubMedGoogle Scholar
• 12 Thie N., Kato T., Bader G.. et al The significance of saliva during sleep and relevance of oro-motor movements. Sleep Med Rev 2002; 06: 213-227
  CrossrefPubMedGoogle Scholar
• 13 Nakamura Y., Kubo Y., Nozaki S., Takatori M.. Cortically induced masticatory rhythm and its modification by tonic peripheral inputs in mobilized cats. Bull Tokyo Med Dent Univ 1976; 23: 101-107
  PubMedGoogle Scholar
• 14 Lund J.P., Sasamoto K., Murakami T., Olsson K.A.. Analysis of rhythmical jaw movements produced by electrical stimulation of motor-sensory cortex of rabbits. J Neurophysiol 1984; 52: 1014-1029
  PubMedGoogle Scholar
• 15 Huang C.S., Hiraba H., Sessle B.J.. Input–output relationships of primary face motor cortex in the monkey (Macaca fascicularis). J Neurophysiol 1989; 61: 350-362
  PubMedGoogle Scholar
• 16 Komuro A., Masuda Y., Iwata K.. Influence of food thickness and hardness on possible feed forward control of the masseteric muscle activity in the anaesthetized rabbit. Neurosci Res 2001; 39: 21-29
  CrossrefPubMedGoogle Scholar
• 17 Copray J.C.V.M., Ter Horst G.J., Liem R.S.B.. Neurotransmitter and neuro-peptides within the mesencephalic trigeminal nucleus of the rat: an immunohistiochemical analysis. Neuroscience 1990; 37: 399-411
  CrossrefPubMedGoogle Scholar
• 18 Kolta A., Dubuc R., Lund J.P.. An immunocytochemical and autoradiographic investigation of the serotonergic innervations of trigeminal mesencephalic and motor nuclei of the rabbit. Neuroscience 1993; 53: 1113-1126
  CrossrefPubMedGoogle Scholar
• 19 Liem R.S.B., Copray J.C.V.M., Van der Want J.J.L.. Dopamine immunoreactivity in the rat mesencephalic trigeminal nucleus: an ultra-structural analysis. Brain Res 1997; 755: 319-325
  CrossrefPubMedGoogle Scholar
• 20 Lobbezoo F., Lavigne G.J., Tanguay R.. The effect of catecholamine precursor L-dopa on sleep bruxism: a controlled clinical trial. Mov Disord 1997; a 12: 73-78
  CrossrefPubMedGoogle Scholar
• 21 Lavigne G.J., Brousseau M., Montplaisir J., Mayer P.. Pain and sleep disturbance. In: Lund J., Lavigne G., Dubner R., Sessle B.. eds. Orofacial Pain: From Basic Science to Clinical Management. 2001. Quintessence; Chicago: 139-150
  Google Scholar
• 22 Micheli F., Pardal M.F., Gatto M.. Bruxism secondary to chronic antidopaminergic drug exposure. Clin Neuropharmacol 1993; 16: 315-323
  CrossrefPubMedGoogle Scholar
• 23 Amir I., Hermesh H., Gavish A.. Bruxism secondary to antipsychotic drug exposure: a positive response to propranolol. Clin Neuropsychopharmacol 1997; 20: 86-89
  PubMedGoogle Scholar
• 24 Sjoholm T., Lehtinen I., Piha S.J.. The effect of propranolol on sleep bruxism: hypothetical considerations based on a case study. Clin Auton Res 1996; 06: 37-40
  CrossrefPubMedGoogle Scholar
• 25 Jackson D.M., Jenkins O.F., Ross S.B.. The motor effects of bromocriptin- a review. Psychopharmacology 1988; 95: 433-446
  PubMedGoogle Scholar
• 26 Hindle A.T.. Recent developments in the physiology and pharmacology of 5-hydroxytryptamine. Br J Anaesth 1994; 73: 395-407
  CrossrefPubMedGoogle Scholar
• 27 Adams J.K., Doyle D., Ford I.. Diffuse axonal injury in head injury: definition, diagnosis and grading. Histopathology 1989; 15: 49-59
  CrossrefPubMedGoogle Scholar
• 28 Bullock R, Nathoo N. Injury and cell function. In: Head Injury — Pathophysiology and Management. PL Reilly and R Bullock ed., 2nd ed. [Chapter 6]: 113–138.
  PubMed
• 29 Delahunty T.K., Jiang J.Y., Black R.T.. Differential modulation of carbachol and trans-ACPB-stimulated phosphoinositide turnover following traumatic brain injury. Neurochem Res 1995; 20: 405-411
  CrossrefPubMedGoogle Scholar
• 30 Kuroda Y., Dewar D., Bullock R.. Early changes in second messenger but not receptor binding sites after acute subdural hematoma – an in vitro autoradiographic study. J Neurotrauma 1993; 10: 47-55
  CrossrefPubMedGoogle Scholar
• 31 Bortolotto Z.A., Bashir Z.L., Davies C.K.. A molecular switch activated by metabotropic glutamate receptors regulates induction of long-term potentiation. Nature 1994; 368: 740-743
  CrossrefPubMedGoogle Scholar
• 32 McIntosh T.K., Yu T., Gennarelli T.A.. Alteration in regional brain catecholamine concentration after experimental brain injury in rat. J Neurochem 1994; 63: 1426-1433
  PubMedGoogle Scholar
• 33 Bales J.W., Kline A.E., Wagner A.K.. Targeting dopamine in acute traumatic brain injury. Open Drug Discov J 2012; 02: 119-128
  PubMedGoogle Scholar
• 34 Alexander G.E., Crutcher M.D.. Functional architecture of basal ganglia circuits: neural substrate for parallel processing. Trends Neurosci 1990; 13 (07) 266-271 [Pubmed: 1695401]
  CrossrefPubMedGoogle Scholar
• 35 Graybiel A.M.. Neurotransmitters and neuromodulators in the basal ganglia. Trends Neurosci 1990; 13 (07) 244-254
  CrossrefPubMedGoogle Scholar
• 36 Calabresi P., Gubellini P., Centonze D.. Dopamine and cAMP- regulated phosphoprotein 32 kDa controls both striatal long-term depression and long term potentiation, opposing forms of synaptic plasticity. J Neurosci 2000; 20 (22) 8443-8451 [Pubmed: 11069952]
  PubMedGoogle Scholar
• 37 Olney J.W., Zorumski C.F., Stewart G.R.. Excitotoxicity of L-dopa and 6-OH dopa: implication for Parkinson's and Huntington's disease. Exp Neurol 1990; 108 (03) 269-272 [Pubmed: 1972067]
  CrossrefPubMedGoogle Scholar
• 38 Sinet P.M., Heikkila R.E., Cohen G.. Hydrogen peroxide production by rat brain in vivo. J Neurochem 1980; 34 (06) 1421-1428 [Pubmed: 7830086]
  CrossrefPubMedGoogle Scholar
• 39 Brunmark A., Cadenas E.. Oxidation of quinines by H2O2: formation of epoxy- and hydroxyquinone adducts and electronically states. Basic Life Sci 1988; 49: 81-86 [PubMed: 3074797]
  PubMedGoogle Scholar
• 40 Beal M.F.. Experimental model of Parkinson's disease. Nat Rev Neurosci 2001; 02 (05) 325-334 PubMed: 11331916]
  PubMedGoogle Scholar
• 41 Blum D., Torch S., Lambeng N.. Molecular pathways involved in the neurotoxicity of 6-OHDA, dopamine and MPTP: contribution to apoptotic theory in Parkinson's disease. Prog Neurobiol 2001; 65 (02) 15-172 [PubMed: 11403877]
  PubMedGoogle Scholar
• 42 Azdad K., Gall D., Woods A.S.. Dopamine D2 and adenosine A2A regulate NMDA-mediated excitation in accumbens neurons through A2A-D2 receptor heteromerization. Neuropsychopharmacology 2009; 34 (04) 972-986 [PubMed: 18800071]
  CrossrefPubMedGoogle Scholar
• 43 Hernandez-Lopez S., Tkatch T., Perez-Graci E.. D2 dopamine receptors in striatal medium spiny neurons reduce L-type Ca2+ currents and excitability via a novel PLC [beta] 1-IP3-calcineurin-signaling cascade. J Neurosci 2000; 20 (24) 8987-8995 [PubMed: 11124974]
  PubMedGoogle Scholar
• 44 So C.H., Verma V., Alijaniaram M.. et al Calcium signaling by D5 dopamine receptor and D5-D2 receptor hetero-oligomers occurs by a mechanism distinct from that for dopamine D1-D2 hetero-oligomers. Mol Pharmacol 2009; 75 (04) 843-854 [PubMed:19171671]
  CrossrefPubMedGoogle Scholar
• 45 Wagner A.K., Sokoloski J.E., Ren D.. Controlled cortical impact injury affects dopaminergic transmission in the rat striatum. J Neurochem 2005; 95 (02) 457-465
  CrossrefPubMedGoogle Scholar
• 46 Nishi A., Bibb J.A., Matsuyama S.. Regulation of DARPP-32 dephosphorylation at PKA- and Cdk5-sites by NMDA and AMPA receptors: distinct roles of calcineurin and protein phosphatase-2A. J Neurochem 2002; 81 (04) 832-841
  CrossrefPubMedGoogle Scholar
• 47 Greengard P., Allen P.B., Nairn A.C.. Beyond the dopamine receptors: the DARPP-32/protein phosphatase 1 cascade. Neuron 1999; 23 (03) 435-447
  CrossrefPubMedGoogle Scholar
• 48 Kurz J.E., Parsons J.T., Rana A.. A significant increase in basal and maximal calcineurin activity following fluid percussion injury in rat. Neurotrauma 2005; 22 (04) 476-490
  CrossrefPubMedGoogle Scholar
• 49 Kim Y.S., Joh T.H.. Microglia, major player in brain inflammation: their roles in the pathogenesis of Parkinson's disease. Exp Mol Med 2006; 38 (04) 333-347
  CrossrefPubMedGoogle Scholar
• 50 Teismann P., Schulz J.B.. Cellular pathology of Parkinson's disease: astrocytes, microglia and inflammation. Cell Tissue Res 2004; 318 (01) 149-161
  CrossrefPubMedGoogle Scholar
• 51 Liepert J., Schardt S., Weiller C.. Orally administered atropine enhances motor cortex excitability: a transcranial magnetic stimulation study in human subjects. Neurosci Lett 2001; 300: 149-152
  CrossrefPubMedGoogle Scholar
• 52 Nakamura Y., Katakura N.. Generation of masticatory rhythm in the brainstem. Neurosci Res 1995; 23: 1-19
  CrossrefPubMedGoogle Scholar
• 53 Sjoholm T.. Sleep Bruxism: Pathophysiology, Diagnosis and Treatment (PhD Thesis). 1995. University of Turku; Turku Finland:
  Google Scholar
• 54 Sjoholm T., Lowe A., Miyamoto K.. Sleep bruxism in patients with sleep-disordered breathing. Arch Oral Biol 2000; 45: 889-896
  CrossrefPubMedGoogle Scholar
• 55 Grestner G.E., Goldberg L.J., De Bruyne K.. Angiotension H-induced rhythmic jaw movements in ketamine-anaesthetised guinea pigs. Brain Res 1989; 478: 233-240
  CrossrefPubMedGoogle Scholar
• 56 Soto-Trevino C., Thoroughman K.A., Marder E., Abbott L.F.. Activity dependent modification of inhibitory synapses in models of rhythmic neural networks. Nat Neurosci 2001; 04: 297-303
  CrossrefPubMedGoogle Scholar
• 57 Jones B.E.. Basic influence of brain reticular formation, including intrinsic monoaminergic and cholinergic neurons on fore-brain mechanisms of sleep and waking. In: Mancia, Marini. eds. The Diencephalons and Sleep. 1990. NY Raven Press, Ltd; 31-48
  Google Scholar
• 58 Jones B.E.. Basic mechanism of sleep wake states. In: Kryger, Roth, Dement. eds. Principles and Practice of Sleep Medicine. 2000. W.B.Saunders; Philadelphia: 134-154
  Google Scholar
• 59 Montplaisir J., Nicholas A., Godbout R.. Restless leg syndrome and periodic limb movement disorder. In: Kryger, Roth, Dement. eds. Principles and Practice of Sleep Medicine. 2000. W.B.Saunders; Philadelphia: 134-154
  Google Scholar
• 60 Nitz D., Siegel J.. GABA release in the dorsal raphae nucleus: role in control of REM sleep. Am J physiol 1997; 273: R451-R455
  PubMedGoogle Scholar
• 61 Gallopin T., Fort P., Eggermann E.. Identification of sleep promoting neurons in vitro. Nature 2000; 404: 992-995
  CrossrefPubMedGoogle Scholar
• 62 Kendel E.R., Schwartz J.H., Jessell T.M.. Principle of Neural Science. 4th. ed. 2000. McGraw Hill; NY:
  Google Scholar
• 63 Siegel J.M.. Brainstem mechanism generating REM sleep. In: Kryger, Roth, Dement. eds. Principles and Practice of Sleep Medicine. 2000. W.B.Saunders; Philadelphia: 112-133
  Google Scholar
• 64 Eberle-Wang K., Lucki I., Chesselet J.-F.. A role of the sub-thalamic nucleus in 5 HT 2c induced oral dyskinesia. Neuroscience 1996; 72: 117-128
  CrossrefPubMedGoogle Scholar
• 65 Fornal C.A., Metzler C.W., Marrosu F.. A subgroup of dorsal raphae serotonergic neuron in cat is strongly activated during oral-buccal movements. Brain Res 1996; 716: 122-133
  PubMedGoogle Scholar
• 66 Lavigne G.J., Manzini C.. Sleep bruxism and concomitant motor activity. In: Kryger, Roth, Dement. eds. Principles and Practice of Sleep Medicine. 2000. W.B.Saunders; Philadelphia: 773-785
  Google Scholar
• 67 Di V., De Blasi A., Di Giulio C., Esposito E.. Role of 5-HT 2c receptors in the control of central dopamine function. Trends Pharmacol Sci 2001; 22: 229-232
  CrossrefPubMedGoogle Scholar
• 68 Seifritz E., Stahl S.M., Gillin J.C.. Human sleep EEG following the 5 HT 1A antagonist pindolol: possible disinhibition of raphae neuron activity. Brain Res 1997; 759: 84-91
  CrossrefPubMedGoogle Scholar
• 69 Jacobs B.L., Fornal C.A.. Activity of serotonergic neurons in behaving animals. Neuropsychopharmacology 1999; 21: 9S-15S
  CrossrefPubMedGoogle Scholar
• 70 Landolt H.-P., Meier V., Burgess H.J.. et al Serotonin 2 receptors and human sleep: effect of selective antagonist on EEG power spectra. Neuropsychopharmacology 1999; 21: 455-466
  CrossrefPubMedGoogle Scholar