Bruxism Associated with Anoxic Encephalopathy: Successful Treatment with Baclofen

Introduction. Bruxism is a movement disorder characterized by grinding and clenching of the teeth. Etiology of bruxism can be divided into three groups: psychosocial factors, peripheral factors, and pathophysiological factors. Methods. The clinical investigation was conducted at King Khaled Hospital in Hail, Saudi Arabia, in 2012. Results. A 16-year-old Saudi female was brought to the hospital in a comatose state and with generalized convulsive seizures secondary to acute anoxic encephalopathy. In the third week of hospitalization, while still in a state of akinetic mutism, she developed incessant bruxism which responded favorably to a GABA receptor agonist (baclofen). Conclusion. Our data support the hypothesis that bruxism emanates from imbalance or dysregulation of the neurotransmitter system. Larger scale studies will be needed to confirm this hypothesis. 1. Introduction The term “la bruxomanie” was first introduced by Marie Pietkiewicz in 1907 [1]. Bruxism is a diurnal or nocturnal parafunctional activity that includes tooth clenching, bracing, gnashing, and grinding. Its prevalence rates range from 5 to 96 percent in the adult population. Bruxism is of great interest to a wide variety of specialties. Although many etiologic factors such as stress and occlusal disorders have been proposed [2–5], bruxism’s exact pathophysiology still remains unknown. Bruxism has been reported in certain neurological disorders such as Rett syndrome, mental retardation, anoxic encephalopathy, and cerebellar hemorrhage [6–8]. Tooth clenching, grinding, or both have been reported to be particularly prevalent in patients with idiopathic, tardive, and posttraumatic cranial dystonia, a neurological disorder manifested by abnormal spasms and movements involving the orolingual-facial musculature [9, 10]. Various treatment modalities have been reported to be useful for bruxism, but there is no general agreement as to what the best therapeutic option is. Most cases are treated with an occlusal appliance, while severe cases are treated with botulinum toxin injections [11]. We report for the first time successful treatment of bruxism with a gamma-aminobutyric acid (GABA) agonist. 2. Case Report A 16-year-old Saudi female was brought to the emergency room of King Khaled Hospital by the Red Cross in an unconscious state with generalized tonic/clonic seizures. She had a history of epilepsy in childhood. Her mother reported that she had been raped and nearly strangulated prior to arrival. She was immediately intubated and placed on mechanical respiration. She was, however, assisting