Palato-pharyngo-laryngeal myoclonus: an unusual cause of dysphagia and dysarthria

Abstract

AbstarctWe describe a case of palato-pharyngo-laryngeal myoclonus, an unusual variant of palatal myoclonus, which presented with dysphagia and dysarthna. The aetiology and presenting features of myoclonus are discussed. Various treatment options are considered.

Speech–Language Pathology Evaluation and Management of Hyperkinetic Disorders Affecting Speech and Swallowing Function

“… 8 , 9 , 26 , 89 , 100 – 104 Another common approach identified in this patient population is the use of compensatory strategies that modify posturing or manner of swallowing to improve airway closure and bolus clearance (see Table 5 ). 8 , 9 , 26 , 89 , 100 , 101 , 104 , 105 In some cases, exercise approaches can be utilized to improve muscle strength and structural performance during mastication and swallowing (see Table 5 , indirect treatment). 26 , 27 Adaptations or compensations for improving eating and swallowing safety as well as cognitive contributions to dysphagia may also be recommended (see Table 5 ).…”

“…In such cases, dysphagia symptoms may reflect the disruption of airway protection timing and impaired bolus transit during swallowing. 103 , 105 , 111 For example, one case example 111 exhibited disruption of breathing related to rhythmic myoclonic jerks affecting the soft palate and larynx associated with difficulty swallowing solid and liquid foods. This individual’s speech and swallowing symptoms were significantly alleviated using a pharmacologic treatment, sodium valproate.…”

“…Other case examples reported disruption of speech and swallowing due to rhythmic myoclonic jerks affecting the pharynx and larynx. 103 , 105 In these cases, dysphagia was characterized as difficulty initiating swallowing and aspiration during swallowing 105 as well as delayed onset of swallowing and laryngeal penetration/aspiration of liquids. 103 Safe oral intake for both cases was achieved using compensatory strategies, 105 or diet modifications 103 for dysphagia treatment (see Table 5 ).…”

Effectiveness of Combining Behavioral Treatment With Valproic Acid for Dysphagia Caused by Palatal Myoclonus in Patients With Stroke: Two Case Reports

“…PM is strongly associated with dysphagia involving the swallowing muscles such as the soft palate, pharynx, and larynx [ 1 2 3 4 ]. Involuntary contractions of these muscles may cause penetration or aspiration of bolus materials [ 4 ], as suggested by previous case reports showing symptoms of swallowing difficulty in this condition [ 1 5 6 ]. Hence, the close relationship between PM and dysphagia and its unique characteristics underscore the need for specific therapeutic interventions.…”

Facio-Oculo-Palatal Myoclonus due to Pontine Cavernous Angioma

“…It can be idiopathic, but is also seen in association with a variety of neurologic insults including stroke, multiple sclerosis, tumors, trauma and metabolic encephalopathy [4][5][6]. We present a patient with delayed faciooculo-palatal myoclonus after a pontine hemorrhage due to a cavernous angioma involving the dorsal pontine area.…”