Acupuncture in the treatment of temporo-mandibular disorders in Sydenham's chorea patient: a case report by ProQuest


More Info
									                                           Downloaded from on January 5, 2010 - Published by


REFERENCES                                                         in order to identify if the facial spasms in     transcutaneous electrical nerve stimulation),
1.    Sator-Katzenschlager SM, Scharbert G, Kozek-                 Sydenham’s chorea can leave to a temporo-        the symptoms improved after a single
      Langenecker SA, et al. The short- and long-term              mandibular joint dysfunction.                    acupuncture session and did not return
      benefits in chronic low back pain through adjuvant              At the examination, the patient was calm      within one year follow up period.
      electrical vs manual auricular acupuncture. Anesth
      Analg 2004;98:1359–64                                        without any signs of anxiety. The patient        Evidently, a placebo effect cannot be
2.    Sator-Katzenschlager SM, Szeles JC, Scharbert G, et          presented involuntary movements at the           excluded through this case report, thus
      al. Electrical stimulation of auricular acupuncture points   temporo-mandibular joint. On palpation of        further studies must be performed to vali-
      is more effective than conventional manual auricular         the area, moderate tension was found in the      date our current findings with a larger
      acupuncture in chronic cervical pain: a pilot study.         region of LU19 and TE21. Despite the fact        number of patients and a control group.
      Anesth Analg 2003;97:1469–73.
                                                                   that the patient did not show any obvious           Although numerous approaches have been
                                                                   signs of apprehension, it was decided to         described for this condition, acupuncture is
                                                                   approach both, the muscle-joint component        increasingly being used as an alternative to
Acupuncture in the treatment of                                    of the temporo-mandibular disorders and          conventional treatment. In this single case
                                                                   the psychological factor. Acupuncture treat-     report, the relation between time and treat-
temporo-mandibular disorders in                                    ment was started at the first appointment.       ment solution suggests that the acupuncture
Sydenham’s chorea patient: a                                       The patient was seated comfortably and           contributed to its resolution. Expectation
                                                                   upright in a dental chair. The skin surface      may also have played a role. This report is
case report                                                        was prepared with alcohol swabs. Local           the first known published description of the
A case report for a woman with Sydenham’s                          points (tender spots in temporo-mandibular       use of acupuncture in the treatment of
chorea is presented, and suggests that this                        joint) were needled first at the ST6, ST7,       temporo-mandibular disorders in a patient
treatment may be worth trying in other                             LU19, TE21 and VG20 acupuncture points.          with Sydenham’s chorea.
patients with this condition.                                      Disposable       filiform       needles    (0.      There are several factors in this case that
                                                                   3 mm625 mm) were inserted at relevant            favour causality rather than coincidence.
                                                                   points until de qi sensation (soreness, numb-    First, spontaneous improvement or resolu-
CASE HISTORY                                                       ness, distension or heaviness) was achieved,     tion in less than 1 year from presentation is
A 33-year-old woman, a housewife with two                          with rotation clockwise and anti-clockwise       rare. The second reason to attribute the
daughters, initially presented at the acupunc-                     for 3–5 s and left in situ for 20 min without    improvement to acupuncture is a plausible
ture clinic with rapid, irregular and aimless                      any stimulation. Various distal points were
involuntary movements of the arms and legs,                                                                         physiological mechanism. The gate control
                                                                   used in an attempt to improve the effective-     theories and modern pain physiology try to
trunk and facial muscles. The medical history                      ness of the treatment, as is a common
revealed that at age of four the patient                                                                            provide a scientific ground for the actions of
                                                                   practice in traditional Chinese acupuncture.     acupuncture. Acupuncture acts as a pain-
developed her first episode of rheumatic fever,                    The distal LI4, LR3 and ST36 were used on
without obsessive-compulsive behaviour.                                                                             reliever by stimulating the acupuncture
                                                                   both sides.                                      points, which affect the A-b nerve fibres.
However, the patient showed symptoms                                  On the following visit a week later, the
compatible with Sydenham’s chorea such as                                                                           With the constant twirling of the needle, a
                                                                   patient claimed that her symptoms                steady stream of non-pain impulses is
choreiform movements, hypotonia, motor                             improved. In addition, the involuntary
agitation, loss of coordination, gait distur-                                                                       transmitted to the substantia gelatinosa
                                                                   movements in the hands were also reduced         causing the gate to close. Once the gate is
bances and impediment of speech, associated                        and the patient was able to go back to her
with joint pain, most prominent in at the                                                                           closed, subsequent pain impulses coming
                                                                   embroidery. The patient received a similar
temporo-mandibular joint. The patient has                                                                           from the slow conducting C fibres cannot
                                                                   acupuncture treatment on her second visit,
been treated since then with haloperidol.                                                                           pass through. Thus, no pain is felt. The
                                                                   and on the third appointment she claimed to
Therefore, during the two pregnancies she                                                                           impulses from the A-b fibres can be relayed
                                                                   be still improving. In view of her continued
presented an exacerbation of her previous                                                                           to the thalamus, which serves as the final
                                                                   improvement, it was decided to provide
symptoms of Sydenham’s chorea, which is a                                                                           gate. Once the gate in the thalamus is
                                                                   subsequent treatment in a weekly basis, to
very common finding, reporting mainly limita-                                                                       closed, analgesia is produced on the entire
To top