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Oncologic causes of oculopalatal tremors: neurophysiology and treatment

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Abstract

Oculopalatal tremor (OPT) is an acquired pathology characterized by continuous and rhythmical soft palatal movements combined with pendular nystagmus. Aside from vascular lesions, oncological masses affecting the dentatorubro-olivary pathway can impair brainstem and/or cerebellar pathways, manifesting as dyssynchronous movement. In this review, we delve into the neurophysiology of OPT along with oncological causes and treatment options based on the most recent clinical trial data. This literature review includes medication treatment data from clinical trials enrolling individuals with features of OPT, including acquired pendular nystagmus (APN). Trials were deemed eligible for inclusion in this review if one or more participants had symptoms determined by the trial authors to be caused by OPT. Trials investigating the treatment of APN secondary to a separate cause, such as multiple sclerosis, were excluded from this review. Several early treatments failed to demonstrate a benefit for patients with APN due to OPT. Trials of anticholinergic agents were largely ineffective and poorly tolerated. Botulinum toxin A demonstrated improvement in APN symptoms. Most recently, trials including memantine and gabapentin have demonstrated success with attenuation of APN. Surgical modalities such as DBS have yet to show improvement, though with only a single case report as evidence. Oculopalatal tremor is a unique manifestation of posterior fossa tumors disrupting the Guillain–Mollaret triangle. Symptom control through medication management has had limited success attributed to poor response and medication intolerance. Surgical modalities like DBS may have an emerging role in OPT treatment by targeting dyssynchronous activity in the dentatorubro-olivary pathway.

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Authors and Affiliations

  1. Department of Neurosurgery, Desert Regional Medical Center, 1150 N. Indian Canyon Dr., Palm Springs, CA, 92262, USA

    Brian Fiani

  2. Department of Radiation Oncology, Mount Sinai Hospital, New York, NY, USA

    Juliana Runnels

  3. Department of Neurology, University of Washington, Seattle, WA, USA

    Kasra Sarhadi

  4. College of Osteopathic Medicine, Michigan State University, East Lansing, MI, USA

    Erika Sarno & Athanasios Kondilis

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Correspondence to Brian Fiani.

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Fiani, B., Runnels, J., Sarhadi, K. et al. Oncologic causes of oculopalatal tremors: neurophysiology and treatment. Acta Neurol Belg 121, 1111–1116 (2021). https://doi.org/10.1007/s13760-021-01761-8

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