Contemporary thinking implicates a fundamental failure of T regulatory cell function in GCA pathophysiology, representing opportunity for novel therapeutic avenues. Tocilizumab has become the first Food and Drug Administration-approved treatment for GCA following demonstration of efficacy and safety in a phase 3 clinical trial. There have been significant parallel advances in both our understanding of GCA pathophysiology and treatment. Tocilizumab, and other agents currently under investigation in phase 2 and 3 clinical trials, presents a new horizon of hope for both disease remission and avoidance of glucocorticoid-related complications.

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Palatal tremor (PT) (or myoclonus) is a rare movement disorder comprising 2 forms: essential PT (EPT) and symptomatic PT (SPT). c The rhythmic movement of the PT may be unilateral or bilateral with partial or complete rhythmicity. During sleep, tremor ceases in EPT but not in SPT. c Treatment for SPT includes medication such as valproate, clonazepam, or trihexyphenidyl; botulinum toxin has been successful in only a few reported cases. Oysters c Examination of the palate and careful review of imaging should be done in patients who present with progressive ataxia to recognize the clinical syndrome of progressive ataxia and PT. c MRI may demonstrate olivary pseudohypertrophy with contrast enhancement in PT and should not be confused with malignancy or stroke.