Botulinum toxin is effective and safe for palatal tremor

Penney, Susannah; Bruce, Iain; Saeed, Shakeel R

doi:10.1007/s00415-006-0039-9

Cited by 84 publications

(18 citation statements)

References 15 publications

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“…There have been suggestions of testing drugs that reduce electrotonic coupling among hypertrophied inferior olive neurons by blocking connexons like quinine, carbenoxolone, or mefloquine (27), but no study has since been published. Botulinum toxin has been tested on pendular nystagmus in OPT with variable success (106) and in clicking tinnitus in PT (107). …”

Section: Treatmentmentioning

confidence: 99%

Hypertrophic Olivary Degeneration and Palatal or Oculopalatal Tremor

2017

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Hypertrophic degeneration of the inferior olive is mainly observed in patients developing palatal tremor (PT) or oculopalatal tremor (OPT). This syndrome manifests as a synchronous tremor of the palate (PT) and/or eyes (OPT) that may also involve other muscles from the branchial arches. It is associated with hypertrophic inferior olivary degeneration that is characterized by enlarged and vacuolated neurons, increased number and size of astrocytes, severe fibrillary gliosis, and demyelination. It appears on MRI as an increased T2/FLAIR signal intensity and enlargement of the inferior olive. There are two main conditions in which hypertrophic degeneration of the inferior olive occurs. The most frequent, studied, and reported condition is the development of PT/OPT and hypertrophic degeneration of the inferior olive in the weeks or months following a structural brainstem or cerebellar lesion. This “symptomatic” condition requires a destructive lesion in the Guillain–Mollaret pathway, which spans from the contralateral dentate nucleus via the brachium conjunctivum and the ipsilateral central tegmental tract innervating the inferior olive. The most frequent etiologies of destructive lesion are stroke (hemorrhagic more often than ischemic), brain trauma, brainstem tumors, and surgical or gamma knife treatment of brainstem cavernoma. The most accepted explanation for this symptomatic PT/OPT is that denervated olivary neurons released from inhibitory inputs enlarge and develop sustained synchronized oscillations. The cerebellum then modulates/accentuates this signal resulting in abnormal motor output in the branchial arches. In a second condition, PT/OPT and progressive cerebellar ataxia occurs in patients without structural brainstem or cerebellar lesion, other than cerebellar atrophy. This syndrome of progressive ataxia and palatal tremor may be sporadic or familial. In the familial form, where hypertrophic degeneration of the inferior olive may not occur (or not reported), the main reported etiologies are Alexander disease, polymerase gamma mutation, and spinocerebellar ataxia type 20. Whether or not these are associated with specific degeneration of the dentato–olivary pathway remain to be determined. The most symptomatic consequence of OPT is eye oscillations. Therapeutic trials suggest gabapentin or memantine as valuable drugs to treat eye oscillations in OPT.

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Section: Treatmentmentioning

confidence: 99%

Hypertrophic Olivary Degeneration and Palatal or Oculopalatal Tremor

2017

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“…Its efficacy in EPT stems from the fact that it binds to cholinergic nerve endings and causes muscular paralysis, thereby reducing muscular contractions. Its long-term use has not been found to cause permanent muscular degeneration [22, 23]. …”

Section: Discussionmentioning

confidence: 99%

Botulinum toxin treatment for essential palatal tremors presenting with nasal clicks instead of pulsatile tinnitus: a case report

et al. 2016

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BackgroundIn this study, we report a rare case of an adult patient with essential palatal tremors (EPT) presenting as nasal clicks, instead of otic clicks or objective pulsatile tinnitus in common EPT.Case presentationNasal endoscopic examination and EMG recordings of the soft palate muscles were performed to confirm the source of the clicks. Initial treatment with lidocaine provided symptomatic relief for four hours. The patient was then treated with four simultaneous injections of 12.5 U of botulinum toxin in four different sites of the soft palate. Palatal tremors and clicks completely disappeared within three months of treatment.ConclusionsTo our knowledge, this is the first case of EPT that presented with nasal clicks. We recommend that otolaryngologists should expect this rare occurrence in the clinical setting, and handle patients presenting with such symptoms with care and compassion in order not to worsen their psychological status.Electronic supplementary materialThe online version of this article (doi:10.1186/s13005-016-0129-6) contains supplementary material, which is available to authorized users.

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“…Up to 30 units are injected unilaterally into the soft palate at the site of insertion of the TVP and levator [9]. Side effects of treatment are usually brief and include voice change and nasopharyngeal regurgitation [10]. More severe side effects are rare and include Eustachian tube dysfunction and velopharyngeal inadequacy [8].…”

Section: Discussionmentioning

confidence: 99%

Essential palatal myoclonus following dental surgery: a case report

2013

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IntroductionVarious presentations of essential palatal myoclonus, a condition characterized by clicking noises and palatal muscle spasm, have been reported in the literature. We are reporting the first case of essential palatal myoclonus following dental treatment.Case presentationA 31-year-old Caucasian man presented to our Ear, Nose and Throat department complaining of objective clicking tinnitus occurring immediately after he had undergone root canal treatment on his right lower third molar 3 months ago. Magnetic resonance imaging of his head revealed no abnormalities in the cerebrum, cerebellum or brainstem making the diagnosis essential palatal myoclonus. He returned a week later, and 20 units of botulinum toxin A (Allergan) were injected into his left tensor veli palatine muscle. He reported an immediate improvement; however, symptoms recurred 6 months later.ConclusionsDental treatment can be a trigger of essential palatal myoclonus. Botulinum toxin injections are an effective treatment for short-term relief of symptoms.

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Botulinum toxin is effective and safe for palatal tremor

Cited by 84 publications

References 15 publications

Hypertrophic Olivary Degeneration and Palatal or Oculopalatal Tremor

Hypertrophic Olivary Degeneration and Palatal or Oculopalatal Tremor

Botulinum toxin treatment for essential palatal tremors presenting with nasal clicks instead of pulsatile tinnitus: a case report

Essential palatal myoclonus following dental surgery: a case report

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