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Oculopalatal myoclonus: Eye movement studies, MRI findings and the difficulty of treatment

Eyevolume 11pages1924 (1997) | Download Citation



Two cases of oculopalatal myoclonus with bilateral horizontal gaze palsies are presented. The abnormal vertical eye movements developed several months after brain stem haemorrhage. Eye movement measurements showed rhythmical vertical eye movements at similar rates (2.3 Hz and 2.4 Hz), unaffected by attempts to fixate, converge or gaze in any direction. T2-weighted MRI scans showed bilateral enlargement of the inferior olivary nuclei in both cases, which confirms the expected pathology previously demonstrated on autopsy. Both patients had severe oscillopsia and an attempt was made to improve this by bilateral disinsertion of the vertical rectus muscles. The pendular eye movements continued but were greatly reduced, in one case enough to relieve the oscillopsia. However, after 6 months retrobulbar botulinum toxin was required to continue to provide relief from the oscillopsia. Other treatment options, including pharmacological agents, are discussed.


  1. 1

    Spencer HR . Pharyngeal and laryngeal ‘nystagmus’. Lancet 1886;2:702.

  2. 2

    Guillian G . The syndrome of synchronous and rhythmic palato-pharyngo-laryngo-oculo-diagphr agmatic myoclonus. Proc R Soc Med 1938;31:1031–8.

  3. 3

    Gresty MA, Ell JJ, Findley LJ . Acquired pendular nystagmus: its characteristics, localising value and pathophysiology. J Neurol Neurosurg Psychiatry 1974;37:570–7.

  4. 4

    Gautier JC, Blackwood W . Enlargement of the inferior olivary nucleus in association with lesions of the central tegmental tract or dentate nucleus. Brain 1961;84:341–61.

  5. 5

    Koeppen AH, Barron KD, Dentinger MP . Olivary hypertrophy: histochemical demonstration of hydro-lytic enzymes. Neurology 1980;30:471–80.

  6. 6

    Guillain G, Mollaret P, Bertrand I . Sur la lésion responsable du syndrome myoclonique du tronc cérébral. Etude anatomique d'un cas demonstratif sans lésions focales. Rev Neurol 1933;3:666–74.

  7. 7

    Lapresle J . Rhythmic palatal myoclonus and the dentato-olivary pathway. J Neurol 1979;220:223–30.

  8. 8

    Nakada T, Kwee IL . Oculopalatal myoclonus. Brain 1986;109:431–41.

  9. 9

    Chang YY, Tsia TC, Shih PY, Liu LS . Unilateral symptomatic palatal myoclonus: MRI evidence of contralateral inferior olivary lesion. Kaohsiung J Med Sci 1993;9:371–6.

  10. 10

    Sperling MR, Herrmann C Jr. Syndrome of palatal myoclonus and progressive ataxia: two cases with magnetic resonance imaging. Neurology 1985;35:1212–4.

  11. 11

    Yokota T, Hirashima F, Furukawa T, Tsukagoshi H, Yoshikawa H . MRI findings of inferior olives in palatal myoclonus. J Neurol 1989;236:115–6.

  12. 12

    Massry GG, Chung SM . Magnetic resonance imaging findings in oculopalatal myoclonus. Am J Ophthalmol 1994;117:811–2.

  13. 13

    Uchino A, Hasuo K, Uchida K, Matsumoto S, Tsukamoto Y, Ohno M, Masuda K . Olivary degeneration after cerebellar or brain stem haemorrhage; MRI. Neuroradiology 1993;35:335–8.

  14. 14

    Zarranz JJ, Fontan A, Forcadas I . MR imaging of presumed olivary hypertrophy in palatal myoclonus. AJNR 1990;11:1164.

  15. 15

    Hirono N, Kameyama M, Kobayashi Y, Udaka F, Mezaki T, Abe K, Nishitani N . MR demonstration of a unilateral olivary hypertrophy caused by pontine tegmental hematoma. Neuroradiology 1990;32:340–2.

  16. 16

    Revel MP, Mann M, Brugieres P, Poirier J, Gaston A . MR appearance of hypertrophic olivary degeneration after contralateral cerebellar hemorrhage. AJNR 1991;12:71–2.

  17. 17

    Keane JR . Acute vertical ocular myoclonus. Neurology 1986;36:86–9.

  18. 18

    Matsuo F, Ajax ET . Palatal myoclonus and denerva-tion supersensitivity in the central nervous system. Ann Neurol 1979;5:72–8.

  19. 19

    Goto N, Kaneko M . Olivary enlargement: chronological and morphometric analyses. Acta Neuropathol 1981;54:275–82.

  20. 20

    Kurachi M, Nakamura I, Katsukawa K, Kobayashi K, Sano Y, Isaki K, Yamaguchi N . Olivary hypertrophy in a case with palatal myoclonus: light and electron microscopic study. Folia Psychiatr Neurol Jpn 1985;39:543–50.

  21. 21

    Pierot K, Cervera-Pierot P, Delattre JY, Duyckaerts C, Chiras J, Brunet P . Palatal myoclonus and inferior olivary lesions: MRI pathologic correlation. J Comput Assist Tomogr 1992;16:160–3.

  22. 22

    Deuschl G, Mischke G, Schenck E, Schulte-Monting J, Lucking CH . Symptomatic and essential rhythmic palatal myoclonus. Brain 1990;113:1645–72.

  23. 23

    Itoh Y, Sakata E . Acquired pendular oscillations after brain stem hemorrhage. Acta Otolaryngol 1989;(Suppl)468:205–8.

  24. 24

    Llinas RR, Yarom Y . Electrophysiological properties of mammalian inferior olivary cells in vitro. In: Courville J, de Montigny C, Lemarre Y, editors. The olivary nucleus: anatomy and physiology. New York: Raven Press, 1980:379–88.

  25. 25

    Dubinsky RM, Hallett M, Di Chiro G, Fulham M, Schwankhaus J . Increased glucose metabolism in the medulla of patients with palatal myoclonus. Neurology 1991;41:557–62.

  26. 26

    Lefkowitz D, Harpold G . Treatment of ocular myoclonus with valproic acid. Ann Neurol 1985;17:103–4.

  27. 27

    Ferro LM, Castro-Caldas A . Palatal myoclonus and carbamazepine. Ann Neurol 1981;10:402.

  28. 28

    Sakai T, Shiraishi S, Murakami S . Palatal myoclonus responding to carbamazepine. Ann Neurol 1981;9:199–200.

  29. 29

    Gledhill RF, Wiles CM . Clonazepam and branchial myoclonus. Ann Neurol 1977;1:306–7.

  30. 30

    Jabbari B, Gunderson CH . Palatal myoclonus responding to trihexyphenidyl. Ann Neurol 1983;14:95.

  31. 31

    Magnussen I, Dupont E, Prange-Hansen A, et al. Palatal myoclonus treated with 5-hydroxytryptophan and a decarboxylase inhibitor. Acta Neurol Scand 1977;55:251–3.

  32. 32

    Spalton DJ, Sanders MD, Gresty M, Rosen ES . Ocular myoclonus and oscillopsia: a problem of treatment. Trans Ophthalmol Soc UK 1980;100:507–8.

  33. 33

    Carlow TJ . Medical treatment of nystagmus and ocular motor disorders. Int Ophthalmol Clin 1986;26:251–64.

  34. 34

    Jankovie J, Pardo R . Segmental myoclonus: clinical and pharmacologic study. Arch Neurol 1986;43:1025–31.

  35. 35

    Leigh RJ, Rushton DN, Thurston SE, et al. Effects of retinal image stabilization in acquired nystagmus due to neurologic disease. Neurology 1988;38:122–7.

  36. 36

    Ruben ST, Lee JP, O'Neil, Dunlop I, Elston JS . The use of botulinum toxin for treatment of acquired nystagmus and oscillopsia. Ophthalmology 1994;101:783–87.

  37. 37

    Lee JP . Surgical management of nystagmus. Eye 1988;2:44–7.

  38. 38

    von Noorden GK, Sprunger DT . Large rectus muscle recessions for the treatment of congenital nystagmus. Arch Ophthalmol 1991;109:221–4.

  39. 39

    Colburn JE . Fixation of the external rectus muscle in nystagmus and paralysis. Am J Ophthalmol 1906;23:85–8.

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  1. Oxford

    • S J Talks
    •  & J S Elston


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