LETTER TO THE EDITOR

We read with interest the article by Silva, et al., on a 64 year-old male diagnosed with oro-mandibular dyskinesia induced by wearing a surgical mask [Silva, T. Y. T. et al., 2023]. As soon as the mask was removed, the dyskinesia disappeared [Silva, T. Y. T. et al., 2023]. The pathophysiological background of the phenomenon remained unclear [Silva, T. Y. T. et al., 2023]. The study is excellent but raises concerns that should be discussed.

The video provided cannot be used to assess which type of involuntary movements occurred when putting on the surgical mask. We should know what clues have been used to diagnose hyperkinetic movement disorder, particularly dyskinesia. How did the authors rule out a tic, myoclonus, task-related dystonia, chorea, tremor, Tourette syndrome, psychogenic reaction to the mask? Wearing a transparent mask would have been helpful for assessing the phenomenology of the irregular movements.

A limitation of the study is that no diagnostic work-up was reported [Silva, T. Y. T. et al., 2023]. We should know the results of blood tests, cerebral MRI, cerebral SPECT, and EEG. It is also important to know if the patient was SARS-CoV-2 positive, if he had recently had a SARS-CoV-2 infection, and if he had had received a SARS-CoV-2 vaccination in the last four weeks before the dyskinesias occurred. It is also important to know the reported patient’s history and family history, particularly with regard to hereditary movement disorders. It is also mandatory to report current medication and whether he has taken any illicit drugs. Overall, the interesting study has limitations that call the results and their interpretation into question. Clarifying these weaknesses would strengthen the conclusions and could add value to the study