Abstract
We report clinical and neurophysiological findings in two patients with palatal tremor (PT). In both patients a prompt and persistent suppression of palatal movements and clicking sounds is caused by slight passive or active mouth opening. One patient has a typical essential palatal tremor (EPT) according to current classification criteria. The other one has a PT characterized by involuntary activation of levator veli palatini and genioglossus muscles. Objective clicking sounds were observed late during the course of the disease. A symptomatic aetiology was excluded, suggesting a diagnosis of atypical EPT.
Our observations further confirm that unusual features of some cases may not fit current PT classification criteria. These two cases have several features that distinguish them from voluntary PT and from psychogenic PT. We emphasize that clear cut modulating phenomena may be relevant features in both typical and atypical involuntary EPT. We finally focus on the significance of jaw posture in determining PT suppression in our patients.
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Chen JT, Yu HY, Wu ZA, Kao KP, Hallett M, Liao KK (2000) Modulation of symptomatic palatal tremor by magnetic stimulation of the motor cortex. Clin Neurophysiol 111:1191–1197
Cho JW, Chu K, Jeon BS (2001) Case of essential palatal tremor: atypical features and remarkable benefit from botulinum toxin injection. Mov Disord 16:779–782
Deuschl G, Mischke G, Schenck E, Schulte–Monting J, Lucking CH (1990) Symptomatic and essential rhythmic palatal myoclonus. Brain 113:1645–1672
Deuschl G, Toro C, Valls–Solè J, Zeffiro T, Zee DS, Hallett M (1994) Symptomatic and essential palatal tremor. 1. Clinical, physiological, and MRI analysis. Brain 117:775–788
Deuschl G, Toro C, Hallett M (1994) Symptomatic and essential palatal tremor. 2. Differences of palatal movements. Mov Disord 9:676–678
Deuschl G, Wilms H (2002) Palatal tremor: the clinical spectrum and physiology of a rhythmic movement disorder. Adv Neurol 89:115–130
Deuschl G, Wilms H (2002) Clinical spectrum and physiology of palatal tremor. Mov Disord 17(Suppl 2):S63–S66
Erickson JC, Carrasco H, Grimes JB, Jabbari B, Cannard KR (2002) Palatal tremor and myorhythmia in Hashimoto’s encephalopathy. Neurology 58:504–505
Fabiani G, Teive HA, Sa D, Kay CK, Scola RH, Martins M, Werneck LC (2000) Palatal Myoclonus: report of two cases. Arq Neuropsiquiatr Sep; 58(3B):901–904
Goyal M, Versnick E, Tuite P, Saint Cyr J, Kucharczyk W, Montanera W, Willinsky R, Mikulis D (2000) Hypertrophic olivary degeneration: metaanalysis of the temporal evolution of MR findings. Am J Neurorad 21:1073–1077
Jacobs L, Newman RP, Bozian D (1981) Disappearing palatal myoclonus. Neurology 31:748–751
Jamieson DR, Mann C, O’Reilly B, Thomas AM (1996) Ear clicks in palatal tremor caused by activity of the levator veli palatini. Neurology 46:1168–1169
Jankovik J, Pardo R (1986) Segmental myoclonus. Clinical and pharmacological study. Arch Neurol 43:1025–1031
Katsunari H, Kazuto H, Kenjii H, Takefumi N (2000) EMG activities of the two heads of the human lateral pterigoid muscle in relation to mandibular condyle movement and biting force. J Neurophysiol 83:2120–2137
Klein C, Gehrking E, Vieregge P (1998) Voluntary palatal tremor in two siblings. Mov Disord 13:545–548
Lang AE (2001) Essential palatal tremor. Mov Disord 16(6):1202–1203
Marsden CD, Sheehy MP (1990) Writer’s cramp. Trends Neurosci 13:148–153
Nishie M, Yoshida Y, Hirata Y, Matsunaga M (2002) Generation of symptomatic palatal tremor is not correlated with inferior olivary hypertrophy. Brain 125:1348–1357
Pakiam AS, Lang AE (1999) Essential palatal tremor: evidence of heterogeneity based on clinical features and response to sumatriptan. Mov Disord 14:179–180
Rothwell J (1994) Control of human voluntary movement. Chapman and Hall. London 2nd Edit, p 170
Samuel M, Torun N, Tuite PJ, Sharpe JA, Lang AE (2004) Progressive ataxia and palatal tremor (PAPT). Clinical and MRI assessment with review of palatal tremors. Brain 127:1252–1268
Samuel M, Kleiner–Fisman G, Lang AE (2004) Voluntary control and a wider clinical spectrum of essential palatal tremor. Mov Disord 19:717–719
Tomkinson A, Craven C, Brown MJ (1995) Palatal myoclonus affected by neck position. J Laryngol Otol 110:207
Vieregge P, Klein C, Gehiking E, Kortke D, Kompf D (1997) The diagnosis of "essential palatal tremor". Neurology 49:248–249
Williams DR (2004) Psychogenic palatal tremor. Mov Disord 19:333–335
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Morini, A., Boninsegna, C., Nostro, M. et al. Palatal tremor suppressed by mouth opening. J Neurol 252, 1335–1340 (2005). https://doi.org/10.1007/s00415-005-0861-5
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DOI: https://doi.org/10.1007/s00415-005-0861-5