From the Guidelines
Palatal myoclonus can be treated with medications such as clonazepam, sodium valproate, and levetiracetam, which may be effective in suppressing myoclonic activity. When considering treatment options for palatal myoclonus, it is essential to prioritize medications that have shown efficacy in managing myoclonus. According to the European Resuscitation Council and European Society of Intensive Care Medicine 2015 guidelines for post-resuscitation care 1, clonazepam, sodium valproate, and levetiracetam are antimyoclonic drugs that may be effective in treating myoclonus. Some key points to consider when treating palatal myoclonus include:
- Starting with a low dose of clonazepam, such as 0.5 mg twice daily, and gradually increasing as needed
- Using sodium valproate, with a typical dose range of 250-500 mg twice daily
- Considering levetiracetam, with a typical dose range of 500-1000 mg twice daily
- Being aware that myoclonus can be difficult to treat, and propofol may be effective in suppressing post-anoxic myoclonus 1
- Monitoring patients closely for potential adverse effects and adjusting treatment as needed
- Considering a personalized approach with medication trials and specialist consultation with a neurologist or otolaryngologist to optimize treatment outcomes.
From the Research
Treatment Options for Palatal Myoclonus
- Palatal myoclonus is a rare syndrome characterized by involuntary rhythmical movements of the soft palate, giving rise to clicking objective tinnitus 2.
- Various management regimens have been unsuccessful in treating palatal myoclonus, but botulinum toxin injection to the palatal muscles has shown promise 2, 3, 4, 5.
- The use of botulinum toxin in the treatment of essential palatal myoclonus tinnitus has been effective in relieving tinnitus and cessation of palatal contractions 3.
- Treatment of palatal myoclonus with botulinum toxin injection has been successful in resolving pulsatile tinnitus in patients who failed conservative treatment with anxiolytics 4.
- An algorithm for management with botulinum toxin based on clinical disease characteristics, such as presenting symptoms, clinical examination findings, and involved muscle groups, has been devised 5.
Botulinum Toxin Injection
- The dose and location of botulinum toxin injection depend on the predominant presenting symptom, with 2.5 U injected transorally into the tensor veli palatini muscle for tinnitus, and medially on either side of the uvula for palatal movements 5.
- The dose and interval between doses are titrated according to patient symptoms, with bilateral symptoms requiring alternating injections between sides at sequential visits 3.
- Botulinum toxin dose must be titrated to achieve optimal results in each individual patient, analogous to titrations done for spasmodic dysphonia 4.