Symptomatic palatal tremor: A descriptive cohort study of 27 cases in a tertiary hospital

Abstract

Background: Symptomatic palatal tremor (SPT) is an uncommon hyperkinetic movement disorder caused by the interruption of the dentato-rubro-olivary pathway due to a lesion in the brainstem or cerebellum. Methods: We describe a cohort of consecutive patients with SPT who were assessed by a single neurologist in a tertiary reference center. Results: A total of 27 patients were included in this cohort from 1998 to 2016; 16 males and 11 females, with a mean age of 47 years (range 19-89). The average time from initial insult to a diagnosis of SPT was 14.5 months (range 2-48 months). The most common etiology of SPT was cerebrovascular disease (CVD) in 21 (78%) patients. Other etiologies included infectious and demyelinating diseases of the central nervous system. The remaining unclassified case was accompanied by progressive ataxia pointing toward a neurodegenerative etiology. Twenty-six patients had a history of posterior fossa injury, and all patients had rhombencephalic signs with severe dysarthria. None of them responded significantly to pharmacological treatment. Conclusion: SPT is a more common finding than expected, especially in patients with posterior fossa injury secondary to CVD. The main clinical syndrome was the rhomboencephalic phenotype, with a predominance of dysarthria. There was no effective treatment in any of the patients.