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Palatal tremor - Additional question for Dr. Christian Welsch

July 29, 2012 | 25,00 EUR | answered by Christian Welsch

Introduction

Thank you for your recent assessment, which has been very helpful to me!

The clinics for ENT and Neurology have, as you suspected, diagnosed a Tremor Palatinus and prescribed Clonazepam, which is quite effective.

I even became the attraction of the day, as the disorder - as you said - seems to be quite rare and I was filmed multiple times :-)

I am attaching the report from the Neurology clinic, as I imagine you might still be interested in it (you don't need to say anything about it).

Questions

1) What I still don't understand is why the symptoms are so strongly temperature-dependent and why they only occur at night:

Now with Clonazepam it's better, but otherwise - the colder it is at night, the stronger the symptoms in the morning. The worst situation is: sleeping on a plane, where cold air blows in my face all night. Do you have any idea why this temperature dependency occurs? How do muscles change in cold temperatures?

2) Conversely, I have noticed several times that radiant heat helps if I manage to bring it close enough to my cheek, soft palate area (difficult), for example by sleeping close to an electric radiator (but then there is a risk of burns). Interestingly, it's not enough for the radiator to just be warm, it actually has to be running and emitting radiant heat.

What could help, in my opinion, would be either (externally) some kind of headphones with infrared heat sensors or (internally) some kind of extended dental appliance with adjustable infrared heat sensors in the soft palate area. Have you ever heard of anything like this? Maybe I should try to have something like that developed?

Best regards,
F.S.

Christian Welsch

Dear Mr. S.,

Please excuse my delayed response, I had an internet problem which prevented me from receiving your question. I am glad to hear that initial diagnostic steps have been taken and that you are feeling better with Rivotril.

Regarding your question: primarily, the contractility of the muscles is temperature-dependent. Heat is also used for muscle relaxation. Since there are extremely few people in the world with your medical condition, there may be very little experiential knowledge on this. A Botox treatment of the palate may likely be the most beneficial, as I have successfully treated a patient for facial twitching after an ear operation. However, I have no experience with application in the mucous membranes, so please make sure to thoroughly understand the chances of success and risks involved.

Since you also seem to have sleep disturbances, I would recommend a sleep medical examination, contrary to the findings of the neurologists. If the palate has a functional disorder, breathing pauses during sleep are possible, which could worsen the condition. I suggest getting checked by a sleep medicine specialist with an outpatient examination, known as ambulatory polygraphy.

All the best for you,

C. Welsch