-We describe two cases of palatal myoclonus (PM), one essential and another secondary to a stroke. Case 1: a 64 years old female who developed clicking sounds in both ears after a stroke and three years later on noticed a progressive involuntary movement of the throat associated with rhythmic contractions of the soft palate, muscles of tongue and throat. MRI showed an ischemic area in brainstem. The patient had a partial response to the use of sumatriptan 6 mg subcutaneously. Case 2: a 66 years old female who began with ear clicking at left ear that worsed slowly associated with tinnitus and arrhythmic movements of soft palate and an audible click at left ear. Brain MRI was normal; audiometry showed bilateral neurosensory loss. She was prescribed clonazepan 1 mg daily with complete recovery. Primary and secondary palatal myoclonus share the same clinical features but probably have different pathophysiological underlying mechanisms.KEY WORDS: palatal myoclonus, sumatriptan, clonazepan.
Mioclonia palatal: relato de dois casosRESUMO -Descrevemos dois casos de mioclonia palatal (MP), um essencial e o outro secundário a acidente vascular cerebral (AVC). Caso1: mulher de 64 anos que desenvolveu cliques audíveis em ambos os ouvidos após um AVC e que três anos depois começou a apresentar movimentos involuntários do pálato, músculos do língua e garganta. A ressonância magnética (RNM) mostrou áreas de isquemia no tronco cerebral. A paciente apresentou resposta parcial e não duradoura ao uso subcutâneo de 6 mg de sumatriptano. Caso 2: mulher de 66 anos, com cliques audíveis no ouvido esquerdo que pioraram progressiva e lentamente associados com tinitus e movimentos mais ou menos rítmicos do pálato mole. A RNM encefálica era normal. A audiometria mostrou perda neurossensorial bilateral. Foi medicada com 1,0 mg de clonazepan diariamente com completa recuperação. MP primária e secundária compartilham das mesmas características clínicas, mas evidências sugerem que se devam a diferentes mecanismos fisiopatológicos. PALAVRAS-CHAVE: mioclonia palatal, sumatriptano, clonazepan.Palatal myoclonus (PM) is a form of segmental myoclonus. It is an uncommon, rhythmic, "shock-like" involuntary movement of the muscles of soft palate, throat and other structures derived from the branchial arcs 1-3 . Some authors prefer to call it palatal tremor 3 . Jankovic suggests that the most correct term shall be PM 4 . Although it is a rare condition , it is well established that the anatomic structures involved in the process are almost always in the inferior olivary nucleus -that show an hypertrophic degeneration [1][2][3]5,6 .