Palatal myoclonus: report of two cases

Fabiani, G; Teive, Hélio A.G.; Sá, Daniel S.; Kay, C.K.; Scola, Rosana Hermínia; Martins, Márcio Rodrigo; Werneck, Lineü Cesar

doi:10.1590/s0004-282x2000000500017

Cited by 23 publications

(11 citation statements)

References 13 publications

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“…Objective ear clicks in PT sustained by LVP activity are a very rare finding. After the publication of classification criteria by Deuschl et al [4], this finding has been reported only in one case interpreted as EPT [12] and in two cases interpreted as SPT [8,9]. However, our case is the second one in which LVP activity was documented by direct EMG recordings.…”

Section: Discussionmentioning

confidence: 52%

Palatal tremor suppressed by mouth opening

et al. 2005

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We report clinical and neurophysiological findings in two patients with palatal tremor (PT). In both patients a prompt and persistent suppression of palatal movements and clicking sounds is caused by slight passive or active mouth opening. One patient has a typical essential palatal tremor (EPT) according to current classification criteria. The other one has a PT characterized by involuntary activation of levator veli palatini and genioglossus muscles. Objective clicking sounds were observed late during the course of the disease. A symptomatic aetiology was excluded, suggesting a diagnosis of atypical EPT. Our observations further confirm that unusual features of some cases may not fit current PT classification criteria. These two cases have several features that distinguish them from voluntary PT and from psychogenic PT. We emphasize that clear cut modulating phenomena may be relevant features in both typical and atypical involuntary EPT. We finally focus on the significance of jaw posture in determining PT suppression in our patients.

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Section: Discussionmentioning

confidence: 52%

Palatal tremor suppressed by mouth opening

et al. 2005

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“…We identified 20 cases of post-stroke lingual movement disorders following a PubMed search using the search terms described in Methods. [7][8][9][10][11][12][13][14][15][16][17][18][19][20] Thirteen cases had acute presentation and seven had a chronic presentation. Rippling tongue movements were the most common acute movement disorders described in five cases, followed by myoclonus (n53), dyskinesia (n52), tremor (n52), and dystonia (n51).…”

Section: Resultsmentioning

confidence: 99%

Post-Stroke Lingual Dystonia: Clinical Description and Neuroimaging Findings

Pandey

Tater

2019

Tremor and Other Hyperkinetic Movements

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Background: Lingual dystonia is extremely rare following stroke. We describe clinical features and neuroimaging findings in a series of 11 patients (seven acute and four chronic) with post-stroke lingual dystonia and review the literature. Methods: This was a case series using a preformed structured proforma and review of literature using a PubMed search. Results: In our case series, all patients had dysarthria as a presenting symptom. Seven patients had acute presentation (six had an ischemic infarct and one had thalamic hemorrhage) and four had chronic presentation (all had infarct). All patients except one had small infarcts, with the majority of them in the basal ganglia and subcortical white matter regions. Additional chronic ischemic lesions were seen in all patients with acute presentation. The majority of the patients with acute (five out of seven; 71.42%) presentation had left-sided involvement on imaging. We could identify only one case of acute post-stroke lingual dystonia following the PubMed search. Three other cases of post-stroke lingual dystonia with chronic presentation have been described; however, these were associated with oromandibular or cranial dystonia. Discussion: Our results, based on brain lesions, suggest that all lingual dystonia patients with acute infarcts had underlying chronic infarcts. Overall, more leftsided than right-sided strokes were observed with post-stroke lingual movement disorders including dystonia; however, the data were not significant (p51). All patients had dysarthria, with only one having mild tongue weakness and only four having facial weakness. This suggests that the lingual dystonia was responsible for the dysarthria rather than weakness in these patients.

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“…Jabbari et al noticed that there was a good response to the anticholinergic Trihexyphenidyl [77]. However, Fabini et al reported no improvement of EPT with valproate, carbamazepine, levodopa in one patient with EPT but the resolution of EPT with high dose clonazepam (12 mg/day) in another patient [78]. One case report observed the slowing down of the essential palatal tremor with lamotrigine (125 mg twice daily) [12].…”

Section: Treatmentmentioning

confidence: 99%

Palatal Tremor – Pathophysiology, Clinical Features, Investigations, Management and Future Challenges

Bhattacharjee

2020

Tremor and Other Hyperkinetic Movements

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Background: Palatal tremor is involuntary, rhythmic and oscillatory movement of the soft palate. Palatal tremor can be classified into three subtypes; essential, symptomatic and palatal tremor associated with progressive ataxia. Methods: A thorough Pubmed search was conducted to look for the original articles, reviews, letters to editor, case reports, and teaching neuroimages, with the keywords "essential", "symptomatic palatal tremor", "myoclonus", "ataxia", "hypertrophic", "olivary" and "degeneration". Results: Essential palatal tremor is due to contraction of the tensor veli palatini muscle, supplied by the 5 th cranial nerve. Symptomatic palatal tremor occurs due to the contraction of the levator veli palatini muscle, supplied by the 9 th and 10 th cranial nerves. Essential palatal tremor is idiopathic, while symptomatic palatal tremor occurs due to infarction, bleed or tumor within the Guillain-Mollaret triangle. Progressive ataxia and palatal tremor can be familial or idiopathic. Symptomatic palatal tremor and sporadic progressive ataxia with palatal tremor show signal changes in inferior olive of medulla in magnetic resonance imaging. The treatment options available for essential palatal tremor are clonazepam, lamotrigine, sodium valproate, flunarizine and botulinum toxin. The treatment of symptomatic palatal tremor involves the treatment of the underlying cause. Discussion: Further studies are required to understand the cause and pathophysiology of Essential palatal tremor and progressive ataxia and palatal tremor. Similarly, the link between tauopathy and palatal tremor associated progressive ataxia needs to be explored further. Oscillopsia and progressive ataxia are more debilitating than palatal tremor and needs new treatment approaches.

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Palatal myoclonus: report of two cases

Cited by 23 publications

References 13 publications

Palatal tremor suppressed by mouth opening

Palatal tremor suppressed by mouth opening

Post-Stroke Lingual Dystonia: Clinical Description and Neuroimaging Findings

Palatal Tremor – Pathophysiology, Clinical Features, Investigations, Management and Future Challenges

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