Clinical Characteristics of Predominantly Unilateral Oral Cenesthopathy With and Without Neurovascular Contact

Oral cenesthopathy (OC) is characterized by unusual oral discomfort without corresponding evidence, and it has often been categorized as “delusional disorder, somatic type”. Regarding possible causative factors of OC, involvement of neurovascular contact (NVC) of the trigeminal nerve, which transmits not only pain but also thermal, tactile, and pressure sensations, has never been observed yet. This study aimed to investigate the relationship between clinical characteristics of unilateral OC and the presence of trigeminal nerve NVC. This is a retrospective comparative study that involved 48 patients having predominantly unilateral OC who visited the Psychosomatic Dentistry Clinic of Tokyo Medical and Dental University between April 2016 and February 2019. Magnetic resonance imaging was performed to assess NVC presence. The Oral Dysesthesia Rating Scale (Oral DRS) was used to assess the various oral sensations and functional impairments besides psychometric questionnaires. Clinical characteristics were retrospectively obtained from the patients' medical charts. NVC was present in 45.8% (22/48) of the patients. There was no significant difference in sex, age, psychiatric history, oral psychosomatic comorbidity, and psychometric questionnaire scores between patients with and without NVC. However, compared to the patients with NVC, the patients without NVC had significantly higher scores for overall subjective severity of OC symptoms (p = 0.008). Moreover, patients having predominantly unilateral OC without NVC showed significantly higher scores in symptom severity and functional impairment of the following parameters: movement (p = 0.030), work (p = 0.004), and social activities (p = 0.010). In addition, compared with the patients with NVC, the patients without NVC showed significantly higher averages of the total symptom severity scale (SSS) and functional impairment scale (FIS) scores in the Oral DRS (p = 0.015 and p = 0.031, respectively). Furthermore, compared with the patients with NVC, the patients without NVC had significantly higher numbers of corresponding symptoms in both the SSS and FIS (p = 0.041 and p = 0.007, respectively). While NVC may be involved in the indescribable subtle OC symptoms, more complex mechanisms may also exist in OC patients without NVC, which yield varying and more unbearable oral symptoms.

Oral Cenesthopathy Proceeding Dementia with Lewy Body: a Case Report

We herein report a case of oral cenesthopathy that proceeded dementia with Lewy body (DLB). A 70-year-old female presented with oral cenesthopathy. She was diagnosed with major depression/late-onset schizophrenia and treated with paroxetine and perospirone. Subsequently, she developed severe parkinsonism. Her diagnosis changed to DLB based on clinical features and her magnetic resonance imaging, MIBG scintigraphy, and DAT scans. After tapering off paroxetine and perospirone, the patient was treated with donepezil and levodopa. The DLB symptoms, including oral cenesthopathy and parkinsonism, were relieved. This case indicates that oral cenesthopathy may occur as an early symptom of DLB.

Oral Cenesthopathy Proceeding Dementia With Lewy Body: A Case Report

Somatic hallucination is defined as the false sensation of an occurrence in the body. When the hallucination is grotesque and visceral, it is classified as a cenesthopathy (1). Cenesthopathy is likely influenced by culture; one study reported that, of the seven unique countries from which patients were recruited, those from Ghana and those with chronic schizophrenia were significantly more likely to report cenesthesia (2).

Oral cenesthopathy proceeding dementia with Lewy body: a case report

Background We herein report a case of oral cenesthopathy that proceeded dementia with Lewy body (DLB). Case presentation: A 70-year-old female presented with oral cenesthopathy. She was diagnosed with major depression/late-onset schizophrenia and treated with paroxetine and perospirone. Subsequently, she developed sever parkinsonism. Her diagnosis changed to DLB based on clinical features and her magnetic resonance imaging, MIBG scintigraphy, and DAT scans. After tapering off paroxetine and perospirone, the patient was treated with donepezil and levodopa. The DLB symptoms, including oral cenesthopathy and parkinsonism, were relieved. Conclusion This case indicates that oral cenesthopathy may occur as an early symptom of DLB.

The difference in clinical characteristics in the patients with unilateral oral cenesthopathy with and without the neurovascular compression of trigeminal nerve: A clinical chart review

Background Oral cenesthopathy (OC) is characterized by unusual sensation in the oral cavity without corresponding medical and dental evidence. Their complaints are vary and some patients show sever symptoms which decline their quality of life. The neurovascular compression (NVC) of trigeminal nerves is known as one of the factors to indicate abnormal sensation in facial area including oral cavity. The aim of the present study was to investigate the pathophysiology of OC by comparing the clinical characteristics of unilateral OC patients with and without trigeminal nerve NVC. Methods This is a retrospective study reviewing medical records of patients diagnosed with unilateral OC seen between April 2016 and February 2019. Magnetic resonance images (MRI) were performed to assess the presence of NVC. Results Among 321 patients who were diagnosed with OC, 87 patients showed unilateral OC. finally, 52 patients who were performed MRI were involved in the present investigation. In 48.1% subjects (25/52), NVC of trigeminal nerves was observed. In the patients without NVC, 85.2% (23/27) were female with significant difference (p = 0.010) compared to the patients with NVC (48.0%, 12/25). There was no significant difference in age, the presence of psychiatric history and psychosomatic dental comorbidity, and the scores of psychological questionnaires. However, in the patients without NVC, significantly higher scores were observed in the symptom severity and the functional impairment as follow; movement (p = 0.042), pain (p = 0.040), work (p = 0.013) and social activities (p = 0.015), compared to the group with NVC. Conclusion These results suggest that unilateral OC has two subtypes based on predominant involvement of peripheral or central nervous system (CNS). The unilateral OC with NVC may involve predominantly peripheral nervous system. Furthermore, the unilateral OC without trigeminal nerve NVC which showed severe functional impairment may be reflected predominant CNS involvement.