Palatal Myoclonus (syn. Palatal Tremor)

Abstract

Symptomatic palatal tremor is caused by a lesion in the triangle of Guillain and Mollaret and is associated with hypertrophic olivary degeneration that has multiple causes. Essential palatal tremor has no currently demonstrable cause and no accompanying physical or radiological signs. But it is probable that an organic genesis will become apparent. I suggest that some examples of palatal tremor may depend on an ‘upper motor neurone type’, i.e. supranuclear, lesion in the striatum or rostral brainstem releasing medullary activation with denervation hypersensitivity of olivary neurones.

Respiratory difficulty with palatal, laryngeal and respiratory muscle tremor in adult-onset Alexander’s disease

“…It has been proposed that the critical lesion lies in the inhibitory GABAergic input from the dentate to the inferior olive, an input that normally promotes closure of gap junctions between olivary dendrites 14. To result in the localised low frequency oscillation of palatal tremor, this process would have to be distinct somehow from the gap junction opening that has been proposed to result in the higher frequency more widespread oscillation of essential tremor 15 16…”

Mollaret’s Meningitis

“…The first, discussed in this issue [1], was his anatomical description of the connections between the dentate nucleus, red nucleus and the contralateral inferior olivary nucleus (the Guillain–Mollaret triangle) [2] and its relation to palatal myoclonus [3]. The second came in 1944, when he described in three adult patients recurrent benign endothelio-leukocytic aseptic meningitis, a syndrome of brief attacks of meningitis with no evident cause [4].…”

Neuro-Behçet Disease Presenting With Oculopalatal Tremor

“…Our patient had bilateral OPT and bilateral ION pseudohypertrophy. In a review of the literature, Pearce (3) reported that in 287 cases of PT, no cause could be found in 25% and these patients typically lacked radiographic abnormalities. The finding of bilateral ION pseudohypertrophy without other radiographic abnormalities in our patient is unusual.…”

“…Palatal tremor (PT), also termed palatal myoclonus, refers to rhythmic jerking movements of the throat and soft palate associated with damage to the dento-rubro-olivary pathways, referred to as the triangle of Guillain and Mollaret (3). Several cases of PT have been associated with NBD (4-7).…”