Palatal Myoclonus: Treatment with Clostridium botulinum Toxin Injection
Palatal myoclonus is a rare movement disorder of the soft palate marked by involuntary rhythmic contractions occurring from 40 to 240 times per minute. Synchronous audible clicking tinnitus accompanies the palatal contractions. Therapy in the past for palatal myoclonus has been less than optimal and riddled with side effects from multiple medications. The advent of botulinum toxin in the treatment of movement disorders has opened a whole new avenue for therapy. The following case details one of the new and expanding ways to implement botulinum toxin in the treatment of palatal myoclonus.
A 59-year-old woman had an 8-year history of gradual onset bilateral ear clicking. The clicking worsened to the point at which the patient's husband heard it at night, and the patient noticed contractile movements of her soft palate and uvula. She denied any history of neurologic disorders or head trauma.
Evaluation revealed normal tympanic membranes with no obvious movement or clicking during gross palatal contractions. Nasopharyngoscopy and the neurologic examination were normal. Pure-tone audiometry was normal, and a magnetic resonance image showed no detectable central nervous system lesions. The diagnosis was confirmed with a reflex decay mode tracing of left ear stimulation, which displayed irregular movements of the tympanic membrane corresponding to the patient's complaint of clicking (Fig. 1). She was unable to tolerate standard medical treatment because of systemic side effects. Furthermore, her medical problems limited our surgical options, and we elected a trial of Clostridium botulinum toxin injection.
A 27-gauge needle was used as a monopolar recording device to localize the tensor veli palatini muscle. The recording needle was connected to the electromyography (EMG) machine, and needle placement was confirmed with EMG evidence of rhythmic contractions, which were rhythmic but irregular with about 78 to 84 contractions per …
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Botox injections can be a good option. You need a skilled doctor to put medicine in the right area. Speach will be effected and your swollowing might also be effected. Again this is not a cure and temporary relief with side effects is what you might expect on the best case senerio.
John Lieurance, DC
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