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Tremor and Other Hyperkinetic Movements... Jun 2020There is little published work describing the electrophysiological characteristics of essential palatal tremor, a condition now believed by many to be a functional...
BACKGROUND
There is little published work describing the electrophysiological characteristics of essential palatal tremor, a condition now believed by many to be a functional (psychogenic) movement disorder.
CASE REPORT
Here we combine electroencephalography and electromyography with time-locked video recordings to document two cases of essential palatal tremor in which a definitive diagnosis is achieved using these electrophysiological tools.
DISCUSSION
We believe that sharing how these objective tools can be used to diagnose a functional movement disorder, as well as providing more published evidence to support the functional origin of essential palatal myoclonus, will help to diagnose this condition in the future.
Topics: Contingent Negative Variation; Electroencephalography; Electromyography; Essential Tremor; Humans; Male; Middle Aged; Palatal Muscles; Somatoform Disorders
PubMed: 32775024
DOI: 10.5334/tohm.70 -
Tremor and Other Hyperkinetic Movements... Jun 2020It is well known that myoclonus can be a paraneoplastic manifestation of underlying malignancy.
BACKGROUND
It is well known that myoclonus can be a paraneoplastic manifestation of underlying malignancy.
CASE REPORT
A 78-year-old male diagnosed with papillary variant non-small cell lung cancer (NSCLC) presented with tremulousness that rapidly evolved into severe, diffuse myoclonus with prominent palatal involvement requiring intubation. The generalized myoclonus resolved with on levetiracetam, chemotherapy and immune modulation. While low titer positive P/Q type calcium channel autoantibodies were detected, it's etiologic relevance is unclear.
DISCUSSION
This case highlights a rare neurologic paraneoplastic presentation of papillary NSCLC. It also illustrates the importance of monitoring airway safety when myoclonus is generalized.
HIGHLIGHTS
A new, rare paraneoplastic presentation of papillary variant non-small cell lung adenocarcinoma is described. The patient presented with severe diffuse myoclonus with prominent palatal involvement without encephalitis that responded to a combination of chemotherapy, immune modulation, and levetiracetam. No clear causal antibody was found.
Topics: Adenocarcinoma, Papillary; Aged; Anticonvulsants; Antineoplastic Combined Chemotherapy Protocols; Autoantibodies; Carboplatin; Carcinoma, Non-Small-Cell Lung; Dexamethasone; Humans; Intubation, Intratracheal; Levetiracetam; Lung Neoplasms; Male; Myoclonus; Palatal Muscles; Paraneoplastic Syndromes, Nervous System; Pemetrexed; Respiratory Aspiration
PubMed: 32775021
DOI: 10.5334/tohm.42 -
Journal of Movement Disorders Sep 2020Palatal myoclonus generally entails a visible elevation of the palate and uvula and may be accompanied by myoclonus of other oropharyngeal muscles. A 55-year-old man...
Palatal myoclonus generally entails a visible elevation of the palate and uvula and may be accompanied by myoclonus of other oropharyngeal muscles. A 55-year-old man presented with left ear clicking and hyperacusis. Examination showed arrhythmic left lateral soft palate contraction in the tensor veli palatini region without elevation of the uvula, which correlated with an audible click by auscultation with a stethoscope over the left ear. This is a rare case of focal, unilateral palatal myoclonus without visual uvula elevation with concurrent auscultation, demonstrating the importance of careful examination to detect focal myoclonic contractions.
PubMed: 32654474
DOI: 10.14802/jmd.20010 -
Journal of Speech, Language, and... Jun 2020Purpose The purpose of this study was to identify predictors of levator veli palatini (LVP) muscle shortening and maximum contraction velocity in adults with normal...
Purpose The purpose of this study was to identify predictors of levator veli palatini (LVP) muscle shortening and maximum contraction velocity in adults with normal anatomy. Method Twenty-two Caucasian English-speaking adults with normal speech and resonance were recruited. Participants included 11 men and 11 women ( = 22.8 years, = 4.1) with normal anatomy. Static magnetic resonance images were obtained using a three-dimensional static imaging protocol. Midsagittal and oblique coronal planes were established for visualization of the velum and LVP muscle at rest. Dynamic magnetic resonance images were obtained in the oblique coronal plane during production of "ansa." Amira 6.0.1 Visualization and Volume Modeling Software and MATLAB were used to analyze images and calculate LVP shortening and maximum contraction velocity. Results Significant predictors ( < .05) of maximum LVP shortening during velopharyngeal closure included mean extravelar length, LVP origin-to-origin distance, velar thickness, pharyngeal depth, and velopharyngeal ratio. Significant predictors ( < .05) of maximum contraction velocity during velopharyngeal closure included mean extravelar length, intravelar length, LVP origin-to-origin distance, and velar thickness. Conclusions This study identified six velopharyngeal variables that predict LVP muscle function during real-time speech. These predictors should be considered among children and individuals with repaired cleft palate in future studies.
Topics: Adult; Child; Cleft Palate; Female; Humans; Magnetic Resonance Imaging; Male; Muscle Contraction; Palatal Muscles; Palate, Soft; Pharynx; Speech
PubMed: 32539646
DOI: 10.1044/2020_JSLHR-20-00013 -
BMC Neurology Jun 2020Palato-pharyngo-laryngeal myoclonus, a variant of palatal myoclonus, is characterized by involuntary rhythmic movements of palatal, pharyngeal, and laryngeal muscles....
Palato-pharyngo-laryngeal myoclonus with recurrent retrograde feeding tube migration after cerebellar hemorrhagic stroke: a case report and review of hypertrophic olivary degeneration.
BACKGROUND
Palato-pharyngo-laryngeal myoclonus, a variant of palatal myoclonus, is characterized by involuntary rhythmic movements of palatal, pharyngeal, and laryngeal muscles. Symptomatic palatal myoclonus is classically associated with hypertrophic olivary degeneration on MRI imaging due to a lesion in the triangle of Guillain-Mollaret.
CASE PRESENTATION
We report a case of palato-pharyngo-laryngeal myoclonus in a patient post-cerebellar hemorrhagic stroke who presented with recurrent retrograde migration of his gastrojejunostomy feeding tubes. Treatment with either divalproex sodium or gabapentin resulted in a significant decrease in his gastrointestinal symptoms and no further episodes of gastrojejunostomy tube migration.
CONCLUSIONS
This case study indicates that the movement disorder associated with hypertrophic olivary degeneration may involve the gastrointestinal system. Anticonvulsants, such as gabapentin and divalproex sodium, may reduce the severity of gastrointestinal symptoms in cases associated with hypertrophic olivary degeneration. The anatomy of the Guillain-Mollaret triangle and the pathophysiology of hypertrophic olivary degeneration are reviewed.
Topics: Cerebellum; Enteral Nutrition; Humans; Hypertrophy; Intracranial Hemorrhages; Magnetic Resonance Imaging; Male; Middle Aged; Myoclonus; Olivary Nucleus; Stroke
PubMed: 32493244
DOI: 10.1186/s12883-020-01800-6 -
Journal of Speech, Language, and... May 2020Purpose The purpose of this study is to examine the differences in velopharyngeal dimensions as well as levator veli palatini (levator) muscle morphology, positioning,...
Purpose The purpose of this study is to examine the differences in velopharyngeal dimensions as well as levator veli palatini (levator) muscle morphology, positioning, and symmetry of children with repaired cleft palate with velopharyngeal insufficiency (VPI), children with repaired cleft palate with complete velopharyngeal closure, and children with noncleft anatomy. Method Fifteen children ranging in age from 4 to 8 years were recruited for this study. Ten of the participants had a history of repaired cleft palate, half with documented VPI and the other half with velopharyngeal closure. Five participants with noncleft anatomy were matched for age from a normative database. The magnetic resonance imaging protocol, processing methods, and analysis are consistent with that used in previous literature. Results Regarding velopharyngeal dimensions, median values were statistically significantly different between groups for sagittal angle ( = .031) and effective velopharyngeal ratio ( = .013). With respect to the levator muscle, median values were statistically significant for average extravelar length ( = .018), thickness at midline ( = .021), and thickness between the left and right muscle bundles at the point of insertion into the velum ( = .037). Remaining measures were not statistically significant. Conclusions The levator muscle is significantly different among these three groups with respect to thickness at midline, extravelar length, and symmetry at the point of insertion into the velum. Sagittal angle and effective velopharyngeal ratio are also significantly different. Participants with repaired cleft palate and VPI displayed the greatest degree of asymmetry. Future research should control for surgical procedure type to determine the impact of surgery on the levator muscle and surrounding velopharyngeal anatomy.
Topics: Child; Child, Preschool; Cleft Palate; Humans; Magnetic Resonance Imaging; Palatal Muscles; Palate, Soft; Velopharyngeal Insufficiency
PubMed: 32402223
DOI: 10.1044/2020_JSLHR-19-00240 -
Medicina (Kaunas, Lithuania) Apr 2020Subepithelial connective tissue graft (SCTG) from the palate has been considered as the "gold standard" for the treatment of deep gingival recessions. A single-incision...
BACKGROUND AND OBJECTIVES
Subepithelial connective tissue graft (SCTG) from the palate has been considered as the "gold standard" for the treatment of deep gingival recessions. A single-incision technique was reported to allow primary wound healing. A palatal single incision was performed in a rat model. The present study assessed the histology and histomorphometry of palatal wound healing following surgical closure with primary intention.
MATERIALS AND METHODS
Twenty-six 6-month-old male Wistar rats weighing 427-650 g. An incision was made on the maxillary palate. A full thickness flap was raised palatally, and then repositioned and sutured. Two experimental groups: S-Study group, I-Intact control group. Half of the animals were sacrificed 7 days and the remaining 14 days postoperatively. Outcome parameters included-epithelial gap; inflammatory infiltration; vascular fraction, expression of myofibroblasts and stem cell markers within the oral epithelium and stromal cells and physical properties of stromal collagen fibers. Investigations were performed at two time-points (7 and 14 days) during the wound healing process.
RESULTS
The epithelial gap closed completely after 14 days. The inflammatory reaction and vascular fraction were relatively low. Surgical trauma downregulated the expression of cytokeratin (CK) 14 and CK 15, which returned to normal after 14 days. Epithelial differentiation was mediated through upregulation of connective tissue sex- determining-region-Y-box2 (SOX2). Epithelial SOX2, CD34, alpha smooth muscle actin (αSMA) and physical properties of stromal collagen fibers were not influenced by the surgical trauma.
CONCLUSIONS
Surgical trauma followed by palatal wound healing with primary intention in a rat model heals within 14 days. It induces minimal inflammatory infiltration and vascular proliferation. Epithelization is exerted through promotion of epithelial differentiation from stem cells by connective tissue SOX2.
Topics: Animals; Gingival Recession; Humans; Male; Palate; Random Allocation; Rats; Rats, Wistar; Surgical Flaps; Wound Healing
PubMed: 32344587
DOI: 10.3390/medicina56040200 -
BMJ Case Reports Apr 2020An 80-year-old woman presented with a several-year history of progressive hair loss and scalp pruritus. No other rashes or muscle weakness were noted on examination....
An 80-year-old woman presented with a several-year history of progressive hair loss and scalp pruritus. No other rashes or muscle weakness were noted on examination. Scalp biopsy showed interface dermatitis, dense perivascular and periadnexal lymphocytic infiltrate, mucin and scarring alopecia. Laboratory analysis did not show evidence of myositis. The patient was started on hydroxychloroquine for possible cutaneous lupus erythematosus. On follow-up, she presented with a new violaceous rash on the superior eyelids and a well-defined oval patch on the mid-hard palate suspicious for dermatomyositis. Myositis-specific autoantibodies revealed presence of anti-transcriptional intermediary factor-1γ (anti-TIF1γ) in the serum. Anti-TIF1γ autoantibody-positive dermatomyositis is a newly recognised subtype of dermatomyositis that is highly associated with amyopathic disease and has an increased risk of malignancy, making prompt diagnosis crucial. This case highlights the utility of a thorough oral exam in patients suspected to have connective tissue disease as the distinctive ovoid palatal patch is nearly pathognomonic for anti-TIF1γ dermatomyositis.
Topics: Aged, 80 and over; Autoantibodies; Dermatologic Agents; Dermatomyositis; Diagnosis, Differential; Erythema; Exanthema; Female; Humans; Methotrexate; Palate, Hard; Transcription Factors
PubMed: 32332045
DOI: 10.1136/bcr-2019-234111 -
Sensors (Basel, Switzerland) Apr 2020Malocclusion during childhood may affect both morphology and masticatory function and could greatly affect the subsequent growth and development of the jaws and face....
Malocclusion during childhood may affect both morphology and masticatory function and could greatly affect the subsequent growth and development of the jaws and face. The purpose of this study was to evaluate the efficiency of surface electromyography in describing the effects of the rapid palatal expansion (RPE) on Masseter (M) and Temporalis Anterior (T) muscles' activity in 53 children with different types of malocclusion: bilateral posterior crossbite (BPcb), underdeveloped maxillary complex without crossbite (NOcb) and unilateral posterior crossbite on the right (UPCBr) and on the left (UPCBl). The muscular activities during chewing tasks were assessed bilaterally before and after RPE application and three months after removal. Both the envelope's peak (µV) and its occurrence (% of chewing task) were extracted from the surface electromyography signal. Our results showed the presence of statistically significant differences (p < 0.05) on temporomandibular joint muscles, across different assessments, in all the tested populations of subjects. Surface electromyography demonstrated a relationship between the correction of a maxillary transverse discrepancy and the restoration of a muscle's activation patterns comparable to healthy subjects for both T and M.
Topics: Child; Electromyography; Female; Humans; Male; Malocclusion; Masseter Muscle; Palatal Expansion Technique; Temporal Muscle
PubMed: 32272810
DOI: 10.3390/s20072086 -
Journal of Biomechanics May 2020Mobility is a fundamental characteristic of mammalian teeth, and has been widely used to determine individual tooth prognosis. However, the direction and extent of tooth...
Mobility is a fundamental characteristic of mammalian teeth, and has been widely used to determine individual tooth prognosis. However, the direction and extent of tooth movement under functional loads are unknown. This study investigated maxillary molar mobility, alveolar bending, and periodontal space (PDL) fluid pressure during mastication and masseter muscle contraction in young pigs, along with PDL space measurements. Twelve three-month-old farm pigs were instrumented with some or all of the following: (1) ultrasonic crystals, one implanted into the pulp chamber of a deciduous maxillary molar and additional crystals glued onto its buccal and palatal alveolar plates; (2) rosette strain gauges affixed to the buccal and palatal of alveolar ridges; (3) a pressure transducer inserted into palatal alveolar bone facing the PDL. Tooth mobility, alveolar bending, and fluid pressure were simultaneously recorded during unrestrained feeding and subsequent masseter muscle stimulation. The PDL widths were measured using micro-CT. The results indicate that during the power stroke of mastication, (1) the molar displaced buccally and apically (192 ± 95 µm) regardless of the side of chewing; (2) compressive bone strain was greater on the buccal than on the palatal alveolar plate; and (3) PDL pressure increased during the power strok (3.63 ± 0.80 kPa). Masseter contraction produced similar results but with generally lower values. The PDL widths were larger than the range of tooth mobility, and showed no correlation with the mobility. Thus occlusal function causes buccal tipping and intrusion of maxillary molars with concomitant compression of the buccal alveolar plate and raised pressure within the PDL space.
Topics: Alveolar Process; Animals; Periodontal Ligament; Swine; Tooth; Tooth Mobility; Tooth Movement Techniques
PubMed: 32173029
DOI: 10.1016/j.jbiomech.2020.109716