The use of clostridium botulinum toxin in palatal myclonus. A preliminary report

Abstract

Palatal myoclonus is a rare syndrome characterized by involuntary rhythmical movements of the soft palate giving rise to clicking objective tinnitus. The intrusive nature of the tinnitus prompts patients to seek medical advice but to date no single treatment modality has been shown to be consistently effective. We present three cases in whom various management regimes were unsuccessful and in whom botulinum toxin injection to the palatal muscles was undertaken. All three cases were rendered free of their tinnitus with complete abolition of the myoclonus. The questions of optimum dosage as well as frequency of injection will be answered as greater numbers are treated by this method.

Serious and Long-Term Adverse Events Associated with the Therapeutic and Cosmetic Use of Botulinum Toxin

“…The serious adverse events identified in case reports varied from idiosyncratic adverse reactions like anaphylactic shock to dose-dependent adverse reactions like cervical kyphosis and botulism [7,8,9,10,11,12,13,14,15,16,17,18,19,20,21,22,23,24,25,26,27,28,29,30,31,32,33,34,35,36,37,38]. They were attributed to various types and preparations of botulinum toxin.…”

“…In addition, botulism-like generalized weakness has been reported in a patient treated for axillary and palmar hyperhidrosis [12]. Serious adverse events related to the therapeutic use of botulinum toxin include severe velopharyngeal insufficiency, brachial plexopathy, remote muscle weakness, botulism-like generalized muscle weakness, necrotizing fasciitis, crisis of myasthenia, generalized paralysis, marked bilateral blepharoptosis, impairment of speech and chewing, Guillain-Barré syndrome, severe dysphagia, iatrogenic botulism, generalized skin rash, aspiration pneumonia, unilateral facial madarosis and alopecia, and palatal palsy [13,14,15,16,17,18,19,20,21,22,23,24,25,26,27,28,29,30,31,32,33,34,35,36,37,38]. It is interesting that one of the patients presented with generalized weakness 5 years after continued use of botulinum toxin [19].…”

Botulinum toxin is effective and safe for palatal tremor

“…Surgical procedures also vary and again treatment response is variable with risk of significant side effects. There are a number of sporadic cases reported in the literature where botulinum toxin has been used as a second or third line therapy with good symptom control and relatively few reported side effects [3]. We suggest that botulinum toxin is safe and effective first line treatment in the majority of cases.…”

Objective Tinnitus

“…Recently, the most popular, safe and effective therapeutic tool for palatal myoclonic tinnitus has been the injection of botulinum toxin to the palatal muscles. Promising results have been shown in various case reports (Table 1) [3][4][5][6]. Known side effects of botulinum toxin injection to palatal muscles are velopharyngeal insufficiency, hypernasal voice (rhinophonia), and temporary dysphagia due to the excessive neuromuscular inhibition of the adjacent muscles of the palate.…”