Pearls &amp; Oy-sters: Progressive ataxia and palatal tremor

Pradeep, Swati; Grewal, Parneet; Jahan, Samia; Raslau, Flavius D.; Slevin, John T.

doi:10.1212/wnl.0000000000009178

Cited by 6 publications

(8 citation statements)

References 10 publications

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“…Palatal tremor (PT) comprises of two different entities: symptomatic palatal tremor (SPT) and essential palatal tremor (EPT). Palatal tremor may be unilateral, bilateral or asymmetrical 3 . Palatal movement in EPT results from activity of the tensor veli palatini muscle innervated by trigeminal nerve 4,5 .…”

Section: Discussionmentioning

confidence: 99%

Oculopalatal tremor and hypertrophic olivary degeneration

Mahapitiya¹,

Senanayake

Sirisena

et al. 2020

Sri Lanka J. Neurology

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Background: Oculopalatal tremor is characterized by synchronous occurrence of palatal tremor and pendular nystagmus. Oculopalatal tremor (OPT) follows a destructive lesion in the Guillain- Mollaret triangle (GMT) and is associated with hypertrophic inferior olive degeneration (HOD). Case presentation: We report a case of 45 yearsold patient with palatal tremor and pendular nystagmus without ear click. He has had a brainstem stroke 11 months back. He had right side pyramidal drift, left side lower motor neuron type facial weakness and left abducens nerve palsy and mild gait ataxia in addition to oculopalatal tremor. MRI showed hypertrophic inferior olive degeneration. Conclusion: Ear click is an infrequent finding in symptomatic palatal tremor. Additional clinical features may be present in OPT depending on topography of initial structural lesion. There is a wide variety of time intervals between the occurrence of anatomical lesions and recognition of palatal tremor.

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Section: Discussionmentioning

confidence: 99%

Oculopalatal tremor and hypertrophic olivary degeneration

Mahapitiya¹,

Senanayake

Sirisena

et al. 2020

Sri Lanka J. Neurology

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“…Magnetic resonance imaging brain showed hypertrophy of the bilateral inferior olivary nuclei (►Fig. 1).…”

Section: Palatal Myoclonus After Posterior Fossa Surgery In a Child W...mentioning

confidence: 99%

Olivary Hypertrophy Induced Palatal Myoclonus in a Treated Case of Medulloblastoma

Singh,

Lakhanpal,

et al. 2024

Neuropediatrics

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“…The familial variant of PAPT shows brainstem and cervical cord atrophy but no HOD [10,68,70]. Sporadic PAPT shows mostly bilateral HOD.…”

Section: Investigations (Table 4)mentioning

confidence: 99%

“…Rossi et al reported a mild improvement of gait instability but not the palatal tremor after treatment with chenodeoxycholic acid in a patient with PAPT secondary to cerebrotendinous xanthomatosis [68]. Nasal sumatriptan 20 mg temporarily helped palatal tremor although lamotrigine and clonazepam were found to be ineffective [70]. Drugs that can reduce the electronic coupling among the hypetrophic olivary neurons by blocking the connections (quinine or mefloquine) are suggested to control the symptoms although no study is available to support this [28].…”

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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Pearls & Oy-sters: Progressive ataxia and palatal tremor

Cited by 6 publications

References 10 publications

Oculopalatal tremor and hypertrophic olivary degeneration

Oculopalatal tremor and hypertrophic olivary degeneration

Olivary Hypertrophy Induced Palatal Myoclonus in a Treated Case of Medulloblastoma

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

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