Essential palatal tremor: Evidence of heterogeneity based on clinical features and response to sumatriptan

Voluntary control and a wider clinical spectrum of essential palatal tremor

“…In other cases, we found concurrent branchial muscle movements 8, 9, 11–13. Control of EPT is reported with voluntary induction or suppression of activity in branchial muscles: mouth opening2, 12, 14 and closure,10, 11 changing head position,8, 15, 16 teeth clenching, or use of a tongue depressor,12 inhaling, and exhaling,17 relaxation,13 or performing a Valsalva manoeuvre 5…”

“…. Distractibility is also a feature of tics19 and is described in three previous reports of EPT,9, 10, 16 entrainment is described in only one report 16. Bearing these and the above points in mind, patients with EPT need to be assessed in a uniform manner, specifically looking for voluntary control, distractibility, entrainability, and anxiety to establish whether these are the exception or the rule.…”

Psychogenic palatal tremor

“…Aetiological factors in symptomatic palatal tremor (SPT) are varied but usually result in disruption of the dentato‐rubro‐olivary pathway, whereas essential palatal tremor (EPT) appears without a known precipitant. EPT is a clinically heterogenous condition,2 and its definition is blurred by reports of spontaneous resolution3 and voluntary palatal tremor 4, 5. A case of probable psychogenic palatal tremor (PPT) is reported here.…”

Tremor

“…A number of medications have been reported to be successful: valproate, 169 trihexyphenidyl, 168 and flunarizine. 173 The antagonism of 5-hydroxytryptamine receptors may thus play a role at least for some of the patients. 173 The antagonism of 5-hydroxytryptamine receptors may thus play a role at least for some of the patients.…”