Palatal Myoclonus

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Dear All

An absolutely fascinating document on Palatal Myoclonus. This describes everything my first Neurologist said about me. He described it as "Essential PM" I remember that as I said I didn't see anything essential about it.

Below are the Lab tests for it, and also treatment plans including INH (a drug ordinarily used to treat tuberculosis)

Which I know Mr Immunologist has been thinking of using on my main illness.

Hope this info helps all those who have contacted me regarding PM.

http://www.tchain.com/otoneurology/disorders/central/opm.html

Laboratory testing:

Tests that we recommend in all persons with palatal myoclonus:

An imaging study of the brainstem with thin sections through the medulla, preferably a T1-MRI of the posterior fossa with gadolinium. Obtained through physician referral to MRI. Olivary hypertrophy can occur without PM (about 7% of the autopsy population of one hospital specializing in care of elderly patients), and PM can occur without olivary hypertrophy, but they are frequently associated. Physiological recordings of palate and vocal cord, video stroboscopy. Obtained in voice lab.

No other laboratory testing is routine in PM, but there are some investigational possibilities.

Nemni et al (1994), suggested that anti-glutamic acid decarboxylase antibodies ("anti-GAD") should be obtained in cases of essential PM. This test is available as a "send-out" test, to be collected in a gold top. Anti-GAD is also often positive in diabetes, and in a rare neurological condition, the so-called "stiff man syndrome". Anti-GAD has also been reported in several patients with cerebellar ataxia (Abele et al, 1999).

Treatment:

In patients with symptomatic palatal myoclonus, generally no treatment works. In reported papers, about 20% of treatments have been successful, but some indicate that no treatment works. There are sporadic reports however of successful treatment with the following medications:

Sumatriptan (immetrex), a relative of 5-hydroxytryptophan (5-HTP) Ceruletide (analogue of CCK octapeptide). 5-HTP and carbidopa Carbamazepine epam trihexyphenidil (takes large doses -- 60 mg) Clonazepam Sodium Valproate, 900 mg/day (Borggreve and Hageman, 1991) INH (a drug ordinarily used to treat tuberculosis)

Dilantin and barbiturates have been tried unsuccessfully in ordinary PM.

Surgical treatment has been attempted to alleviate ear clicks. Plugging of the eustachian tube and perforation of the tympanic membrane have been tried and failed. Cutting of the levator palatini muscle or the tensor veli palatini have been reportedly associated with partial relief.

Love Aisha.