Oromandibular Dystonia: Ayurveda Understanding

Article by Dr Raghuram Y.S. MD (Ay) & Dr Manasa S, B.A.M.S

Oromandibular Dystonia (OMD) is a rare neurological disorder. It causes involuntary and repetitive contractions in the muscles of the face, jaw and mouth. Eventually these muscle spasms might result in abnormal movements or postures. This causes difficulty in speaking, chewing and even opening and closing of mouth properly. It can either manifest independently or due to other medical conditions, medications or injuries. Injuries affecting the nervous system or the region around the mouth generally cause OMD. Factors like dental procedures, genetic predisposition and trauma are also linked to OMD.

Common symptoms of OMD are difficulty in speaking, chewing or swallowing, unconscious opening, closing or twisting of jaw, depression, reduced quality of life and weight loss.

Related Reading – ‘Oromandibular Dystonia – Ayurveda Understanding’

Ayurveda Understanding of Oromandibular Dystonia

Going through the introduction of OMD, we can see that this condition fits into various conditions which have been explained in Ayurveda.

OMD can be closely studied along with the below mentioned conditions.

Vata Vyadhi

OMD is a neurological disorder. Neurological disorders are discussed under Vata Vyadhi in Ayurveda. So, it makes sense in considering Oromandibular Dystonia as a Vata Vyadhi.

Mukhagata Mamsa-Gata Vata

Since the disease involves involuntary and repetitive muscle contractions in the face, jaw and mouth, it can be included under a condition called ‘Mamsagata Vata’ explained in the context of Vata Vyadhis – special disorders of ‘only vata origin’. Mamsagata vata can occur anywhere in the body. It can be localized to include a small area or can be generalized. Here, to keep it precise we can put it as ‘Mukhagata Mamsa-Gata Vata’ i.e. mamsagata vata occurring in the face.

Pakshavadha or Pakshaghata

‘Paksham Anyataram Hanti Sandhi Bandhan Vimokshayan…’ – this line depicting the symptoms and manifestation of pakshavadha – a condition in which many conditions like paralysis, hemiplegia, paraplegia etc are included, we can see that one portion of the body afflicted by aggravated vata and the joints on that part of the body becomes lax, dislocated or out-balanced, which includes the joints of the face too. ‘Sira Snayu Vishoshya cha’ – the line explaining the pathogenesis of pakshavadha reflects the affliction of nerves by aggravated vata.

Ardita

is a condition which has been correlated to facial paralysis. This can be limited to the face or the facial symptoms can also be a part of hemiparesis or hemiplegia. Though OMD is not facial paralysis, many symptoms found in Ardita are similar to those of OMD. This consideration is important to figure out the treatment options of OMD from the pages of Ayurveda. ‘Jaw Deviating’ is also a type of OMD.

Symptoms of Ardita which are also found in OMD

–        Sankochayati ardhe mukham jihvam karoti cha – constriction of half portion of face and tongue
–        Vakri karoti nasa bhru lalata akshi hanustatha – distortion or crookedness in the nose, eyebrow, forehead, eyes and mandible (lower jaw).
–        Tato vakram vrajati asye bhojanam vakram nasikam – due to the above said distortion, the person finds it difficult to swallow the food
–        Vakram nasikam stabdham netram kathayatah – difficulty in speaking and the nose becomes curved and the eyes become fixed when the person talks
–        Kshavathuh cha nigruhyate – suppression of sneeze
–        Dina jihma samutkshipta kalaa sajjati cha asya vak – difficult to speak. The speech becomes faint, distorted, imperceptible and interrupted.
–        Dantah chalayanti badhyate shravanau bhidhyate svaraha – loosness of teeth, deafness and hoarseness of voice
–        …Akshi…shankha shravana ganda ruk – pain in the eyes, temples, ears and cheek

OMD leads to difficulty in speaking or swallowing and severely impacts the quality of life, as found in the case of Ardita.

Hanugraha

Hanugraha means stiffness of jaw or lockjaw. This is more popularly correlated with OMD and lockjaw or TMJ disorder. This is also a Vata Vyadhi wherein the mouth either stays open or close along with stiffness in the jaw joint i.e. mandibular joint. The movements of the jaw become difficult.

Related Reading – Hanugraha

Ayurveda understanding on the basis of classification of OMD

There are majorly four types of OMD according to modern classification. They are –

Miege’s Syndrome – This condition is a combination of Oromandibular Dystonia, Blepharospasm and dystonic movements of the upper part of the face. We can include this condition too in the ‘Ardita Spectrum’.

From the perspective of causes

Trauma and brain lesions are mentioned amongst the etiological factors of Oromandibular Dystonia. Abhighata – injury / trauma and Marmaghata – injury leading to lesions in the vital organs including the brain are important causative factors of Vata Vyadhi. OMD is also a vata vyadhi.

From the perspective of symptoms

Speaking, chewing and praying can cause or trigger the symptoms of OMD. Symptoms are also triggered by stress. These causes also aggravate vata. These activities can also cause and trigger symptoms of Ardita.

The common symptoms of OMD i.e. dysphonia – difficulty in speaking, dysphagia – difficulty in chewing or swallowing and unconscious opening, closing or twisting of jaw are also found in Ardita.

Symptoms of dystonic spasms in OMD like nasal contractions, facial grimacing, lip pursing, tongue dyskinesia and involuntary closure or opening of jaw are also found in Ardita.

Ayurveda Treatment Principles for Oromandibular Dystonia

Nidana Parivarjana

Avoiding the causative factors is the main principle for treating any disease, OMD not being an exception.

Vata Vyadhi Chikitsa

Basically, Oromandibular Dystonia shall be dealt with on the principles and line of treatment of Vata Vyadhi because the mentioned condition falls under the scope and spectrum of Vata Vyadhis. The pathya apathyas i.e. dos and don’ts related to foods and activities mentioned in the context of Vata Vyadhi should be administered, along with formulations and therapies mentioned in the same context.

Beneficial therapies

Among all principles of treatment, the below mentioned are very much beneficial

1. External Therapies

–        Snehana – external (and internal) oleation – Ksheerabala Taila, Mahamasha Taila, Balashwagandha Taila etc shall be used for Abhyanga – local massage of the afflicted joints

–        Swedana – sudation (local fomentation) – sweating therapy with Nadi Sweda – tubular fomentation, Pinda Sweda – bolus fomentation, Upanaha Sweda – poultice application etc

–        Lepa – anointment with pastes prepared from vata-mitigating herbs like Dashamula Lepa can be used over the jaw joints.

–        Murdni Taila – oil therapies done on head including Shiro Abhyanga, Shiro Dhara, Shiro Vasti and Shiro Pichu are extremely helpful and should be done as and when needed

–        Upanaha – application of hot poultices on the afflicted (jaw) joints is helpful and should be done with upanaha prepared with meat of animals inhabiting marshy lands

2. Panchakarma / Internal Therapies & Others

Nasya – errhines or nasal drops using oils prepared with vata mitigating herbs, mainly nourishing type of nasal drops with formulations like Mahamasha Taila, Ksheerabala Taila 101, Karpasastyadi Taila, Shadbindu Taila etc.

Basti / Vasti – When the disease is chronic and symptoms are stubborn and not responding to the above said conventional and proven therapies and medicines, Vasti should be considered because it is the best remedy for all Vata Disorders. Anuvasana Vasti or Matra Vasti with Ksheerabala Taila, Mahamasha Taila, Guggulutiktaka Ghrita or Mahasneha etc should be used. For Asthapana Vasti, Erandamuladi Kashaya Vasti, Dashamula Ksheera Vasti and Mustadi Yapana Vasti etc should be considered.

Tarpana – Since OMD is a vata vyadhi, Tarpana chikitsa i.e. nourishing treatments are of utmost importance.

Treatment principles of diseases explained in Ayurveda which present with symptoms resembling with OMD

Treatment principles of the conditions explained above shall be considered and implemented skilfully, as and when needed. These conditions include –

–        Ardita
–        Pakshavadha
–        Ekanga Vata
–        Mukhagata Mamsa-Gata Vata
–        Hanugraha / Hanu Stambha
–        Sandhigata Vata
–        Vatarakta

Beneficial Formulations

–        Maharasnadi Kashayam
–        Rasonadi Kashayam
–        Gandharvahastadi Kashayam
–        Mustadi Marma Kashayam
–        Vayu Gulika
–        Dhanwantaram Gulika
–        Mahavata Vidhwans Ras
–        Ekangavira Rasa
–        Balarisht
–        Ashwagandharishta