Olivary Hypertrophy and Palatal Myoclonus

A 64-year-old woman had sudden onset of clouded consciousness, left hemiparesis, and dysarthria. She was found to have pontine hemorrhage on cranial computed tomography at the local hospital. Medical treatment was begun immediately, with subsequent gradual clearing of consciousness. She was admitted to our hospital 2 months later for the purpose of rehabilitation. Neurologic examination showed that she was alert and not demented. Although mild spastic dysarthria was noted, palatal myoclonus was not detected. Tendon reflexes were moderately exaggerated on the left side, with depressed superficial sensation on the same side. She showed intention tremor in the left arm. Ten months later, cranial magnetic resonance images disclosed an olivary prominence of the medulla on the right side on T1-weighted imaging (Figure, A) and a hyperintense ovoid area of the right inferior olive on T2-weighted imaging (Figure, B). This prompted us to reexamine the palate, and we found a palatal myoclonus with a frequency of 60 to 80 times per minute. The woman continues to have mild left hemiparesis, but lives independently.

Another Palatal myoclonus patient finds relief with FCR Treatment.

Screen Shot 2013-11-09 at 7.52.36 AMAnother Palatal myoclonus patient finds relief with FCR Treatment. After a year with palatal myoclonus and many doctors who are unfamiliar with the disease she found Dr. John and Functional Cranial Release or FCR. In this video you will see specific endonasal balloon adjusting along with functional chiropractic neurology.

You can contact Dr John and the Functional Cranial Research Institute at (941) 330-8553 or e-mail him directly at askdrjl@gmail.com

Palatal Myoclonus treatment! There is hope to recover from PM with FCR.

This young lady was brought across the pond from England to Florida with her father who is an Osteopathic Physician.  The results speak can be a correction for folks suffering from palatal myoclonus and traditional treatment offers nothing but botox and medications. Dr. John Lieurance has treated many cases and many success stories.

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Essential Palatal Myoclonus Accompanied with Psychiatric Symptoms

Comment: Below is an article and I have seen many PM patients that seem to suffer phycological issues. It is a complicating factor for both the development and the progression of the disease. It can also make recovery more difficult due to the stress on the central nervous system from mental emotion stress as well as chronic high cortisol. Amazing to see how limited the options they list for their patients being only drugs and surgery when there are so many ways through physical medicine to make changes with PM.

Maryam Norouzian MD, Gholam-Reza Mir-Sepasi MD, FRC Psych

Roozbeh Hospital, Tehran University of Medical Sciences, Tehran, Iran

Abstract
Palatal myoclonus is a rare and unique neurological disorder which can be primary or secondary to lesions of the central tegmental tract in the brain stem. This is a case report of a patient who complained of hearing a continuous disturbing noise for many years. Later an affective disorder superimposed on his previous complaints and confounded his auditory complaints. The co-morbidity resulted in attributing the complaint of hearing noise to his psychotic states and as a hallucinatory phenomenon. Thorough clinical and paraclinical examinations revealed that the patient had primary palatal myoclonus and the misattribution of the auditory complaints had resulted injudicious prescription of antipsychotics. Administration of appropriate therapy resulted in improvement of both problems.

Keywords • Myoclonus • palatal myoclonus • bipolar mood disorder

Introduction

Palatal myoclonus is a rare disorder presenting as unilateral or bilateral rhythmic involuntary movements of the soft palate. This condition which is also called “palatal tremor” or “palatal nystagmus” is a type of segmental myoclonus1,2 which manifest with a frequency of about 1.5-3 Hz.3,4

Patients with palatal myoclonus may complain of hearing an annoying rhythmic click, which is related to the opening and closing of the Eustachian tube due to pharyngeal contractions. This click may be perceived by the examiner by placing a stethoscope over the patient’s ear.3 Palatal myoclonus may also be accompanied with myoclonic contractions of other parts of the body such as extraocular, facial, pharyngeal, laryngeal or diaphragmatic muscles and muscles of the neck, trunk and even the extremities.3

Case Report

A 46-year-old, married, unemployed man from Azarbaijan, north-west of Iran, was hospitalized in Roozbeh Hospital in March 1999 for diagnostic evaluation. The patient’s psychiatric problems started eight years prior to admission following his father’s death and observation of his autopsied corpse. He had desperate thoughts about death, suicidal ideation, delusion of poverty and unusual behavior such as begging and collecting of worn out clothes from time to time. After three years, exacerbation of symptoms resulted in hospitalization in a psychiatric hospital and he received antipsychotic medication. However, the patient’s condition was refractory to drug treatment. Six sessions of electroconvulsive therapy (ECT) were also unsuccessful in controlling the patient’s condition. He had experienced a remarkable functional decline in the past four years and therefore he was hospitalized for further diagnostic evaluation. He displayed symptoms such as elation of mood and affect and uninhibited sexual behavior.

The remarkable point in this patient’s history was the hearing an annoying noise in both ears for 20 years. The noise was heard continuously by the patient and resembled the clicking of a clock. He believed that others would be able to hear the sound if they came close enough to him. No accompanying neurologic symptoms, such as hearing loss or vertigo were reported. The patient believed that his problem had remained unchanged during preceding years. His relatives stated that he was less intelligent than his peers since childhood.

On observing the patient’s general appearance, isotropia of both eyes was evident. The patient had euphoric mood during the interview and seemed to have a subnormal IQ. Results of systemic physical examination were unremarkable. Ocular movement was normal on neurological examination. A continuous rhythmic movement of the soft palate was observed with a frequency of about 80/min. This was accompanied by an audible click which could be heard by the examiner when a stethoscope was placed on the patient’s ear. No other abnormal or involuntary movement was observed in the other parts of the body. In addition, soft neurologic signs such as primitive reflexes (palmomental and mild sucking reflex) and mild dysdiadochokinesia were observed without any significant cerebellar signs.

Psychometric assessment revealed borderline mental retardation, dependent, inactive and immature personality with affective symptoms accompanied by transient episodes of psychotic symptoms.

Laboratory studies included complete blood count (CBC), erythrocyte sedimentation rate (ESR), liver function tests (LFT), thyroid function tests (TFT), electrolytes, blood urea nitrogen, creatinine, triglyceride, cholesterol, fasting blood sugar, urinalysis, VDRL and Wright test and were all normal. The results of audiometric assessment revealed no evidence of hearing loss.

A diagnosis of an affective disorder and palatal myoclonus in a subnormal patient was made and the presence of underlying disorders was evaluated. Palatal electromyography confirmed the presence of palatal myoclonus but the involved muscles were not defined. On ophthalmologic consultation pseudoisotropia due to negative Kappa angle was reported. Electroencephalo-graphy was normal and magnetic resonance imaging (MRI) of the brain revealed mild brain atrophy and mild ventricular dilatation.

Clonazepam (2 mg, qhs) along with carbamazepine (200 mg, bid) was prescribed. The affective symptoms were controlled and palatal myoclonus was virtually stopped with this treatment.

Discussion

Several pathophysiological mechanisms have been proposed to explain this phenomenon.1,4,5 Basically, all the lesions which interrupt the hypothetical circuit (lateral superior cerebellar peduncle, brachium conjunctivum, and dentate nucleus) will result in palatal myoclonus. This circuit is called the triangle of Guillain and Mollaret.

If the cause of palatal myoclonus is identified, the condition is called secondary palatal myoclonus. Otherwise, palatal myoclonus is considered to be primary or essential.

The diagnosis of essential palatal myoclonus is confirmed by the presence of the above mentioned signs and symptoms and paraclinical studies such as brain MRI, electromyography (EMG), somatosensory evoked potential (SSEP), electroencephalography (EEG) and biochemical studies.

In this patient, considering rhythmic myoclonic contractions of the soft palate and the presence of an annoying click audible by the examiner, symptomatologically a palatal myoclonus was diagnosed. Early onset of the disease (26 years old), absence of contractions click during sleep (confirmed by patient’s spouse), absence of cerebellar signs and involuntary movements of other muscles favors the diagnosis of primary (essential) palatal myoclonus.

In order to exclude any underlying disease and due to the fact that the patient had suffered various psychiatric problems, including full-blown affective states, a thorough paraclinical assessment was mandatory. The collected body of evidence suggested that the patient was affected with a subnormal constitution of unknown origin (probably a genetic disorder, birth trauma,…) confirmed by brain atrophy at MRI. The stress experienced at the death of the patient’s father and viewing his corpse probably triggered the appearance of an affective disorder, which initially manifested itself as depression and then as euphoria. According to the DSM-IV criteria, diagnosis of bipolar I disorder was made.6

To date, there has been no known etiological correlation between these two conditions. The rarity of palatal myoclonus and its coexistence with bipolar mood disorder with psychotic features, resulted in misdiagnosis of the sound which was induced by myoclonic jerks as an auditory hallucination. This incorrect interpretation of objective tinnitus as an auditory hallucination resulted in prolonged treatment of the patient with antipsychotic medication.

The treatment of choice for essential palatal myoclonus is the administration of medications, including clonazepam, sodium valproate, tetrabenazine, haloperidol, trihexyphenidyl and carbamazepine. Among these, clonazepam, 0.25-0.5 mg/day increasing gradually to 3.0-6.0 mg/day, and sodium valproate (250 mg/day, increasing to 1000 mg/day) have suppressed the movement in some cases. Surgical treatment for essential palatal myoclonus has not been favorable. Our patient responded to clonazepam and carbamazepine.

This case emphasizes the importance of detailed neurological examination in psychiatric patients. Attributing unusual complaints of mentally disordered individuals to their psychiatric illness is unwarranted and even rare and unusual signs and symptoms merit further scrutiny.

References

Adam R, Victor M, Ropper AH. Principles of Neurology. 6th ed. New York: Mc Graw Hill; 1997: 101-2.
Joynt RY. Clinical Neurology. Vol 2. Rev ed. Pennsylvania: Lippincott-Raven; 1995: Chap 15, 25.
Bradly WG, Daroff RB, Fenichel GM, Marsden CD. Neurology in Clinical Practice. 2nd ed. Boston: Butterworth-Heineman; 1996: 1762-3.
Jnankovie J, Tolosa E. Parkinson’s Disease and Movement Disorders. 2nd ed. Baltimore: Williams & Wilkins, 1993: 318-9.
Fahn S, Greene PE, Ford B, Bressman SB. Handbook of Movement Disorders. 1th ed. Philadelphia: Blackwell science, 1998: 111, 115-116.
Diagnostic and Statistical Manual of Mental Disorder. (DSM-IV). 4th ed. Washington, DC: American Psychiatric Association; 1994: 350-62.

Treating PM with Functional Neurology and Endo-nasal Balloons.

New Webinar Date and Time.

New time is 2pm Hawaii time, as I will be coming to you live from Oahu. Keep in mind the time will be different depending on where you are located. Hawaii is 6 hours behind east coast time so 2pm is 8pm. I hope to see everybody on this one. Please try and log on 10 minutes early so you have time to download the software.

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Please register for Treating PM with Endo-Nasal Balloons and Functional Neurology on Aug 28, 2013 2:00 PM HST at:

https://attendee.gotowebinar.com/register/7767319926813209088

UnknownIn this webinar I will discuss how I have treated Palatal Myoclonus using a safe non-drug, non surgical holistic approach. My treatments are individualized and have been shown to benefit many of the PM patients I have treated. I will discuss the use of endo-nasal balloon inflations and the neurology behind it’s effect in the central nervous system. I will also discuss specific patient I have treated and their results.

After registering, you will receive a confirmation email containing information about joining the webinar.

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Bruce see’s Dr. John after 23 years of PM.

This is Bruce. He has had Palatal myoclonus for 23 years. Palatal Myoclonus is a rare neurological conditionthat results in uncontrolled contractions or spasms of the soft palate & throat along with head pressure & clicking noise & intense pain in the ears. Conventional Medicine has no answers for this condition leaving PM sufferers to live with this horrible disease. This is video footage of Bruce with Dr. John Lieurance, a chiropractor and naturopath who has treated many cases of PM with success using functional neurology and specific endo-nasal balloon inflations.

Learn about a rare neurologic case of Palatal Myoclonus and how Adam was treated.

This is Adam. He has had Palatal myoclonus for 3 and half years. Palatal Myoclonus is a rare neurological conditionthat results in uncontrolled contractions or spasms of the soft palate & throat along with head pressure & clicking noise & intense pain in the ears. Conventional Medicine has no answers for this condition leaving PM sufferers to live with this horrible disease. This is video footage of Adam with Dr. John Lieurance, a chiropractor and naturopath who has treated many cases of PM with success using functional neurology and specific endo-nasal balloon inflations.

 

 

This letter was sent by Adam’s Mom.

Dr. John,

Adam had a great flight home. NO issues with pressure!!! Again…there is no other word besides miraculous. Adam even went food shopping with Howard this morning for the first time in almost a year. Usually, he can’t leave the house.

It is a rare neurological condition (technically myoclonus is not classified as a disease) that results in uncontrolled contractions or spasms of the soft palate and the throat along with head pressure, clicking noise & intense pain in the ears.

Thank you so much. Please let me know when it is on the website and I will send the link to friends and our doctors. I know that they truly care about Adam and will be so happy and interested to understand what you did that helped him. I can’t wait to share it with them. I pray that God works to help spread the word so that functional cranial release can be accepted and understood by the medical community. We will keep you informed about Adam’s progress.

Thank you and may God bless your life as well!

An experience of FCR by a Palatal MyoClonus patient.

 

Post FCR #2 Report 1 week later. I’m back in AZ!

Now I’m down to 4-5 ear clicks in 1 min consistently, and they don’t always happen in both ears anymore either.
Pre FCR, I believe I had to listen to anywhere from 40-100 clicks per min in my ears at all times daily, with some variance depending on the day, stress level, time of month/hormonal cycle. This would not break during sleep.
It’s been amazing to me now that I’m getting more freedom from that constant stressful “noise” how much more of my calm I’ve been able to remain at daily, how much more I enjoy and just want to stay in overall silence now and not have something else “on” like tv, music, a fan, to drown out the noise in my head. I thoroughly enjoy silence and crave it more now.
And I hear my own thoughts better now. It’s incredible.
Huge gifts of positive change. So grateful. :)
Also, the discomfort I had been feeling on the left side of my head above my ear is still now mostly gone post FCR treatment 2 & that whole left side feels more “normal” and not tight.
I’m thinking what little of left of that left side discomfort at this point (which at least is now no longer distracting me from thinking & focusing on my work, writing, reading, etc.) will be entirely gone post FCR treatment 3.
So far, so GREAT! :-) Getting my mind, body & life back, slowly but surely. It feels amazing to experience more of my mind again, even just being able to read again without head pain so I can focus & enjoy it. Something I’d missed so much.
Sincerely,
Heather Dube

Palatal Myoclonus CAN BE CURED! Explore an alternative neurological treatment.

I had a felow travel to Sarasota this week for FCR. I have been working hard on the neurology for PM and feel I am making progress in further perfecting the treatment series. I have some demonstrations in this video of some of the functional neurology I am using with these cases. Each patient is very different and it is unpredictable what therapies will work for each case. A detailed neurological exam in needed to determine how the myoclonus can be augmented. The FCR is performed to take the pressure off the cranium and to allow better oxygen in the central nervous system.