Rhythmic palatal myoclonus (RPM) is a rare movement disorder consisting of continuous synchronous jerks of the soft palate. Patients with essential RPM usually have objective earclicks as their typical complaint due to the pulling on the Eustachian tube. Head pressure iis also common with PM. The cause of PM is not known but it is our opinion that a dis-functional immune system is suspect and genetic predisposition that the inflammation from the immune system favors a certain area in the brain stem.
I am a Chiropractic Neurologist and Registered Medical Assistant and work mainly with chronic neurological conditions such as PM. I have treated dozens of cases and have developed a method called functional cranial release that has given many PM sufferers their life back. Besides FCR our clinic also uses medical treatments such as IV therapies and Stem Cells. It is my opinion that many PM conditions are rooted in chronic inflammation of a specific area in the brain stem. This inflammation can originate from chronic infection or toxic exposure. Many cases continue to have symptoms after this original insult resolves. The dis regulated immune system is at the core of this inflammation! There may be an autoimmune connection is many cases of PM. Our therapy consists of proper testing and targeted therapy to bring back balance to the nervous system. Please feel free to look over some of the video’s on this site explaining what I do and some testimonials from PM patients I have treated.
Please watch this video a couple of times to get very familiar with all the details of this exercise. I am collecting data on how this is helping.
I would like to know the following: A) This made my myoclonus stop or slow down B) This exercise made my myoclonus stop for a period of time after I was finished. C) My head pressure was reduced after doing the exercises. D) I felt this exercise helped my stress and or anxiety that comes with Palatal Myoclonus. Email this to me after 2-3 weeks of doing the work daily please.
The Method
This breathing exercise is similar to Tummo (inner heat) Meditation and Pranayama (yogic breathing). Yet it is something else entirely. While Wim has studied yoga and meditation for many years, this technique primordially comes from what he terms ‘cold hard nature’. By subjecting himself to the bitter conditions of nature, he learned to withstand the extreme forces of cold, heat and fear. If you learn this method or technique correctly, it will empower you do to the same.
The first part is a breathing exercise which can be likened to controlled hyperventilation. This is, of course, an oxymoron. Hyperventilation is something which happens involuntarily. But just imagine the breathing part, without any of stress triggers that normally cause this way of breathing. The image will consist of rapid breathing that makes one languid, invigorates one, makes one high on oxygen. One mechanism of this practice is the complete oxygenation of your blood and cells.
Before you try this at home make sure that you don’t do this: underwater while driving while standing up without approval of your medical caregiver Please be mindful that practicing this method is completely your own risk.
1) Get comfortable and close your eyes
Sit in a meditation posture, whatever is most comfortable for you. Make sure you can expand your lungs freely without feeling any constriction. It is recommended to do this practice right after waking up since your stomach is still empty.
2) Warm Up
Inhale deeply. Really draw the breath in until you feel a slight pressure from inside your chest on your solar plexus. Hold this for a moment and then exhale completely. Push the air out as much as you can. Hold this for a moment. Repeat this warm up round 15 times.
3) 30 Power Breaths
Imagine you’re blowing up a balloon. Inhale through the nose and exhale through the mouth in short but powerful bursts. The belly is pulled inward when you are breathing out and is pulled outward when you are breathing in. Keep a steady pace and use your midriff fully. Close your eyes and do this around 30 times or until you feel your body is saturated with oxygen. Symptoms could be light-headedness, tingling sensations in the body, electrical surges of energy.
4) Scan your body
During the 30 power breaths, delve into your body and become aware of it as possible. Trace your awareness up and down your body and use your intuition as to what parts lack energy and what parts are overflowing. Scan for any blockage between the two. Try to send energy/warmth to those blockages. Then release them deeper and deeper. Tremors, traumas and emotional releases can come up. It can be likened to kundalini rising. Feel the whole body fill up with warmth and love. Feel the negativity burn away.
Often people report swirling colors and other visual imagery during this exercise. Once you encounter them, go into them, embrace them, merge with them. Get to know this inner world and how it correlates to the feeling of tension or blockages in your body.
5) The Hold
After the the 30 rapid succession of breath cycles, draw the breath in once more and fill the lungs to maximum capacity without using too much force. Then push all of the air out and hold for as long as you can. Then place the cold pack over the face and nose. Draw the chin in a bit so as to prevent air from coming in again. Really relax and open all energy channels in your body. Notice how all the oxygen is spreading around in your body. Hold the breath until you experience the gasp reflex on the top of your chest.
6) Recovery Breath
Inhale to full capacity. Feel your chest expanding. Release any tension in the solar plexus. When you are at full capacity, hold the breath once more. Drop the chin to the chest and hold this for around 15 seconds. Notice that you can direct the energy with your awareness. Use this time to scan the body and see where there is no color, tension or blockages. Feel the edges of this tension, go into it, move the energy towards this black hole. Feel the constrictions burning away, the dark places fill with light. Relax the body deeper as you move further inward, let everything go. Your body knows better than you do. After 15 seconds you have completed the first round.
— Its best to do this 3 times but you can start this practice with one or two rounds and work up to the 3. Try to do it daily in the morning and best on an empty stomach. You can do this practice for how long it pleases you.
If you feel dizziness or pain, get out of the posture and lie on your back. Breathe easily again and stop this practice session.
Reserve at least 10-15 minutes after this practice to relax and meditate on your breath as well as the third eye are which correlates to the pineal gland. You can also scan your body.
The tensor veli palatini is innervated by the medial pterygoid nerve, a branch of mandibular nerve, the third branch of the trigeminal nerve (CN V) – the only muscle of the palate not innervated by the vagus nerve.
A focal, hyperintense, nonenhancing lesion and enlargement of the olivary nucleus with a coexisting pontine lesion suggest an injury of the dentato-rubro-olivary pathway, findings that are consistent with hypertrophic olivary degeneration). (3-5)
Hypertrophic olivary degeneration is a form of trans-synaptic degeneration caused by an insult to the neuronal connections of the dentato-rubro-olivary pathway (i.e., the triangle of Guillain and Mollaret) by a primary brainstem inury. (1,2) Disruption of this neuronal pathway affects the reflex arc that controls fine voluntary movements, resulting in signs and symptoms such as palatal myoclonus and dentatorubral tremor. (2,3) This type of astrocytic degeneration has been reported in both children and adults; there is no predilection to either sex. (4)
At any given time following a primary brainstem injury, there may be focal enlargement rather than atrophy of the inferior olivary nucleus. This finding is characteristically identified on MRI. However, failure to properly identify the enlargement may result in a misdiagnosis (e.g, a tumor or multiple sclerosis). (1,5,6)
The Guillain-Mollaret triangle is composed of the dentate nucleus, the red nucleus, and the inferior olivary nucleus. The red nucleus and the ipsilateral inferior olivary nucleus are connected via the central tegmental tract, and the dentate nucleus connects to the contralateral red nucleus through the superior cerebellar peduncle. There are no direct connections between the inferior olivary nucleus and the contralateral dentate nucleus. (1-4) While hypertrophic olivary degeneration can occur with any focal lesion that involves the dentato-rubro-olivary pathway, it is typically associated with lesions that involve the superior cerebellar peduncle (dentatorubral tract), the dentate nucleus, or the central tegmental tract. (2,4)
The triangle is defined by dentate efferents ascending through the superior cerebellar peduncle and crossing in the decussation of the brachium conjunctivum inferior to the red nucleus, to finaliy reach the inferior olivary nucleus (ION) via the central tegmental tract. The triangle is completed by ION decussating efferents terminating on the original dentate nucleus via the inferior cerebellar peduncle.
The central tegmental tract has several connections to the nucleus ambiguous, which gives rise to efferent motor fibers of the vagus nerve that innervates the muscles that control palatal movement. (2,5)
The clinical manifestations of hypertrophic olivary degeneration probably reflect a loss of inhibitory control as a result of disruption of the dentato-rubroolivary pathway. (1-3)
The red nucleus receives most of its fibres from the dentate, but there are also contributions from the emboliform and globose nuclei. Efferents from the dentate nucleus ascend through the superior cerebellar peduncle or brachium conjunctivum and decussate in the caudal midbrain to finally reach the contralateral red nucleus. The rostral third of the red nucleus (parvicellular part) is the end point of the dentatorubral pathway where they have asymmetrical synapses. Fibers from the parvicellular part of the red nucleus descend ipsilaterally via the central tegmental tract to reach the dorsal lamella of the principal inferior olivary nucleus. The triangle is completed by decussating fibers originating from the inferior olivary nucleus, forming the largest component of the inferior cerebellar peduncle (corpus restiform) and terminating on the original dentate nucleus [3]. M. Goyal, E. Versnick, P. Tuite et al., “Hypertrophic olivary degeneration: metaanalysis of the temporal evolution of MR findings,” American Journal of Neuroradiology, vol. 21, no. 6, pp. 1073–1077, 2000.
This is a bidirectional pathway, a coupled system likely to be of a feedback function, because there are also projections from the dentate nuclei to the contralateral caudal inferior olivary nucleus. The inferior olive has an intrinsic slow, rhythmic, and spontaneous activity [6]. M. Goyal, E. Versnick, P. Tuite et al., “Hypertrophic olivary degeneration: metaanalysis of the temporal evolution of MR findings,” American Journal of Neuroradiology, vol. 21, no. 6, pp. 1073–1077, 2000.
it is olivary deafferentation that is thought to trigger the hypertrophic degenerative changes [3].
A midline lesion at the level of the brachium conjunctivum will result in bilateral HOD as the ducassating fibers of the right and left dentate olivary tracts are likely to be involved.
Many collaterals from the reticular formation and from the pyramids enter the inferior olivary nucleus.
Removal of one cerebellar hemisphere is followed by atrophy of the opposite olivary nucleus. Wikiapedia
It is closely associated with the cerebellum, meaning that it is involved in control and coordination of movements,[1] sensory processing and cognitive tasks likely by encoding the timing of sensory input independently of attention or awareness .[2][3][4] Lesions to the inferior olive have been associated with a decreased ability to perfect highly specialized motor tasks, such as improving one’s accuracy in hitting a target with a ball.[5]
Funct Nuero
Alternatively, the downward smooth pursuit pathway could pass through the dentate nuclei.
Pierrot-Deseilligny C, Gaymard B
Service de Neurologie, Unité INSERM 289, Hôpital de la Salpêtrière, Paris, France.
Strategies which activate reflexogenic pathways such as optokinetic stimulations along with voluntary planned movements such as “no no” and “yes yes” head movement ( I usually do this with a head tilt ipsilateral to the weaker cerebellum and opposite to the weaker prefrontal cortex) which may effect activation / afferentation to the inferior olivary nucleus through projections from the reticular formation (possibly some through the cortiobulbar pathways). There are several other tricks I’ve used that have worked with these cases as well. There may be some aspect of dentate activation with smooth pursuits downward which the reflexogenic aspect of a downward optokinetic would create. Generally the OPK that augments the myoclonus has been in a oblique direction. Something that can be done using an app on an iPhone or iPad (OPTOK).
The most interesting aspect of my success has involved the use of endo-nasal balloon manipulations. These are done specifically based on testing done with the patient standing. There are various anatomical area’s challenged by pushing lightly and looking for an unstable reaction. These findings correlate to body positions and specific balloon placements within the nasal passages. The patient is then placed in that position usually using pelvic blocks, head flexed or extended and the head turned to one side. An assistant will hold one of the legs in a slightly flexed position with the foot with inversion and dorsiflexion. The balloon is inflated so that it travels through the nasal passage until just before it begins to enter the throat when it is then deflated and removed. Generally either one side or both will be inflated per day. There are 6 positions that can be used (lower, middle and upper) and I generally will only inflate one area per side. I will do this along with the specific brain activation that seems to decrease the PM symptoms for 4 days straight. Every patient has been a bit different and there has been such a diverse presentation and reaction to treatment. Some seem to be improved more with the balloons and others with the activation / exercise strategies described above. I’m still working on improving my care with these cases as they continue to fly in from around the world to seek care at my office.
Incidentally I have been working with using endo-nasal ballon manipulations for almost 20 years on a variety of conditions including many neurological with much success. I teach these methods as a technique called Functional Cranial Release. You can see more on my web site www.FuncationalCranialRelease.com
In this interview Dr. Lieurance speaks with 2 patients of his that have had success with a uniques chiropractic neurological treatment called functional cranial release. Learn how palatal myoclonus can be treated using FCR and how FCR can treat the PM at it’s cause and not just cover up the symptoms like botox or drugs.
Dr. John Lieurance can you explain what the balloons do? I have tried many of the “conventional” methods for treating this. Next is botox, if that doesn’t work I am interested in trying FCR.
Thanks for asking. I’m still not 100% sure what the primary action the balloons is having for PM or that its multiple. My theory’s are that it could be mechanical see picture below as the manipulation the balloon makes is so close to the action of the the soft palate (also known as velum or muscular palate).
The following are the muscles that can be involved in Palatal Myoclonus.
Tensor veli palatini, which is involved in swallowing
Palatoglossus, involved in swallowing
Palatopharyngeus, involved in breathing
Levator veli palatini, involved in swallowing
Musculus uvulae, which moves the uvula
Notice above the proximity of the nasal cavity to the muscles of the palate/velum. Next look below and see the cranial bones such as the palatine bone, vomer and sphenoid. The vomer is midline nd is not depicted in the second picture but is very important and is manipulated with FCR.
The second theory is that it’s neurological through the trigeminal nucleus and that the inflation is somehow interrupting the windup in the inferior olivary nucleus. Since the sinus’ are innervated through the trigeminal nucleus. The soft palate muscles are innervated by the vagus nerve, with the exception of the tensor veli palatini. The tensor veli palatini is innervated by the mandibular division of the trigeminal nerve. Somatosensory Trigeminal Projections to the Inferior Olive, Cerebellum and other Precerebellar Nuclei. This then corrects the dentato-rubro-olivary pathway that is dysfunctional in Palatal Myoclonus.
To date I have treated 26 cases of palatal myoclonus and have seen more success with these cases than failure. Most cases also have head pressure along with the “clicking” from the myoclonus pulling on the eustachian tube to the inner ear. I have found the head pressure almost always goes away with endo-nasal balloon adjusting (FCR) and the myoclonus has been relieved by the endo-nasal balloons on some cases but generally these cases also require specific activation of the brain described as functional neurological exercises. These exercises are based on a detailed neurological evaluation and also sacciometry testing. I also use Glutathione nebulized (GlutaGenisis) and PEMF of the brain to support the brain with it’s neuroplasticity (healing). Many cases have had the 4 day series and had complete resolution of PM. It should be important to note that some cases required follow up treatment. I generally see these cases for a 4 day course of care. Some cases require follow series. I have seen some cases receive incremental improvements in the symptoms of palatal myoclonus. I
I just wanted to announce to the group I have begun writing a paper for publication in the medical journals. It’s interesting to embark on such a task as it gets one to really delve into the literature to better explain whats happening in the brain with various forms of brain activation in which seem to help create neuroplasticity that re-afferentates the inferior olivary nucleus which is the primary area that is an issue with PM. There are several aspects of my work that could have various effects to correct the myoclonus and in this paper I need to explain all possibilities. I’ll keep you in the loop as my work progresses. Please keep in mind that there will NEVER be a drug or injection or herb that will cure PM!!! All of these do not specifically effect certain pathways. Drugs and such can only increase or decrease brain activity and it is a global effect. What needs to happen with PM is you need to have very specific pathways activated in order to “rewire” the brain. Specifically the dentato-rubro and rubro-olivary (central segmental) pathways. But also there maybe be ways to activate the olivary nucleus to stabilize through presynaptic and postsynaptic pathways. As my work evolves I may be able to better treat the large variety of presentations that PM folks present to me. Sorry for rambling on but it’s exciting to be able to help such a horrible condition!
This is an amazing story from Fox News in Memphis of a man with Palatal Myoclonus who was treated by Dr. Allen Goode who is a certified FCR doctor trained by Dr. John Lieurance, DC the developer of FCR. Functional Cranial Release or FCR is a method which has successfully treated many difficult neurological diseases through the use of specific endo-nasal balloon adjusting along with Chiropractic Functional Neurology. Dr. John Lieurance has successfully treated more Palatal myoclonus patients than any other single physician on the planet which makes him the worlds expert on the disease. He has many of these cases posted on his web site www.palatalmyoclonushelp.com where dozens of real patients share there struggles with PM and the successful results through the FCR treatment. Dr. Lieurance personally coached Dr. Goode with Joel in his treatment and hopes that eventually with the right combination of care Joel can live completely free of PM.
This was a young man who traveled from California to Florida to receive FCR. His condition was treated using endo-nasal balloon adjustments, PEMF, Glutathione nebulizer, and Functional Chiropractic Neurology. Dr. John Lieurance is leading the way in the treatment of Palatal Myoclonus and has treated more of these cases world wide than any other hospital, clinic, or single physician.
This was a woman who traveled from virginia to Florida to receive FCR. Her condition was treated using endo-nasal balloon adjustments, PEMF, Glutathione nebulizer, and Functional Chiropractic Neurology.
This was a young man who traveled from Ireland to Florida to receive FCR. His condition was treated using endo-nasal balloon adjustments, PEMF, Glutathione nebulizer, and Functional Chiropractic Neurology. Dr. John Lieurance is leading the way in the treatment of Palatal Myoclonus and has treated more of these cases world wide than any other hospital, clinic, or single physician.
The below is this patient!
Essential palatal myoclonus following dental surgery: a case report.
Authors
Lam JH, et al. Show all
Journal
J Med Case Rep. 2013 Oct 14;7(1):241. doi: 10.1186/1752-1947-7-241.
Affiliation
College of Medicine, University of Edinburgh, 47 Little France Crescent, Edinburgh EH16 4TJ, UK. H.P.J.Lam@sms.ed.ac.uk.
Abstract
INTRODUCTION: Various presentations of essential palatal myoclonus, a condition characterized by clicking noises and palatal muscle spasm, have been reported in the literature. We are reporting the first case of essential palatal myoclonus following dental treatment.
CASE PRESENTATION: A 31-year-old Caucasian man presented to our Ear, Nose and Throat department complaining of objective clicking tinnitus occurring immediately after he had undergone root canal treatment on his right lower third molar 3 months ago. Magnetic resonance imaging of his head revealed no abnormalities in the cerebrum, cerebellum or brainstem making the diagnosis essential palatal myoclonus. He returned a week later, and 20 units of botulinum toxin A (Allergan) were injected into his left tensor veli palatine muscle. He reported an immediate improvement; however, symptoms recurred 6 months later.
CONCLUSIONS: Dental treatment can be a trigger of essential palatal myoclonus. Botulinum toxin injections are an effective treatment for short-term relief of symptoms.
Rhythmic palatal myoclonus (RPM) is a rare movement disorder consisting of continuous synchronous jerks of the soft palate. Patients with essential RPM usually have objective earclicks as their typical complaint due to the pulling on the Eustachian tube. Head pressure iis also common with PM. The cause of PM is not known but it is our opinion that a dis-functional immune system is suspect and genetic predisposition that the inflammation from the immune system favors a certain area in the brain stem.
