Trial of Oral Metoclopramide on Diurnal Bruxism of Brain Injury
A 36-year-old male, who had no significant medical history nor neurologic abnormalities, was involved in a motorcycle accident. He was admitted to the emergency room unconscious, and after being diagnosed with bilateral frontal and right temporal intracranial hemorrhage (), he underwent craniectomy and hematoma evacuation. Two years after the onset of the injury, he was transferred to the department of rehabilitation for intensive therapy. The K-MMSE score at the time was 15. A manual muscle power test showed that the MRCs of both the upper and lower extremities of the right side were grade IV, and those of the upper and lower extremities of the left side were grade II and I, respectively. He had suffered from teeth grinding and jaw clenching for 2 years but had not received any treatment. The bruxism occurred during the daytime and subsided during sleep. There was no dystonia of the tongue, face or elsewhere. Bruxism was refractory to bromocriptine therapy. Oral metoclopramide administration of 9 mg per day was started to treat the bruxism, and it improved dramatically three days after the initiation of the medication. Bruxism did not recur during the course of the metoclopramide therapy. A cranial computerized tomography scan revealed extensive encephalomalacia in the bilateral frontal lobes and the right temporal lobe from the previous trauma. The EEG was normal. The patient also did not take any medication that may have induced bruxism or decreased the effects of the metoclopramide or levodopa.