Department of Neurosurgery, Desert Regional Medical Center, 1150 N. Indian Canyon Dr., Palm Springs, CA, 92262, USA.
Department of Radiation Oncology, Mount Sinai Hospital, New York, NY, USA.
Acta Neurol Belg. 2021 Oct;121(5):1111-1116. doi: 10.1007/s13760-021-01761-8. Epub 2021 Jul 20.
Oculopalatal tremor (OPT) is an acquired pathology characterized by continuous and rhythmical soft palatal movements combined with pendular nystagmus. Aside from vascular lesions, oncological masses affecting the dentatorubro-olivary pathway can impair brainstem and/or cerebellar pathways, manifesting as dyssynchronous movement. In this review, we delve into the neurophysiology of OPT along with oncological causes and treatment options based on the most recent clinical trial data. This literature review includes medication treatment data from clinical trials enrolling individuals with features of OPT, including acquired pendular nystagmus (APN). Trials were deemed eligible for inclusion in this review if one or more participants had symptoms determined by the trial authors to be caused by OPT. Trials investigating the treatment of APN secondary to a separate cause, such as multiple sclerosis, were excluded from this review. Several early treatments failed to demonstrate a benefit for patients with APN due to OPT. Trials of anticholinergic agents were largely ineffective and poorly tolerated. Botulinum toxin A demonstrated improvement in APN symptoms. Most recently, trials including memantine and gabapentin have demonstrated success with attenuation of APN. Surgical modalities such as DBS have yet to show improvement, though with only a single case report as evidence. Oculopalatal tremor is a unique manifestation of posterior fossa tumors disrupting the Guillain-Mollaret triangle. Symptom control through medication management has had limited success attributed to poor response and medication intolerance. Surgical modalities like DBS may have an emerging role in OPT treatment by targeting dyssynchronous activity in the dentatorubro-olivary pathway.
眼-腭震颤（OPT）是一种获得性疾病，其特征是连续的、有节奏的软腭运动，伴有摆动性眼球震颤。除了血管病变外，影响齿状核-红核-橄榄束通路的肿瘤也会损害脑干和/或小脑通路，表现为不同步运动。在这篇综述中，我们深入探讨了 OPT 的神经生理学，以及基于最新临床试验数据的肿瘤学病因和治疗选择。本文献综述包括了临床试验中药物治疗 OPT 的数据，这些临床试验纳入了具有 OPT 特征的个体，包括获得性摆动性眼球震颤（APN）。如果一项试验的一个或多个参与者的症状被试验作者确定为 OPT 引起，则该试验被认为符合纳入本综述的标准。本综述排除了研究治疗由其他原因引起的 APN 的试验，如多发性硬化症。几项早期治疗因 OPT 导致的 APN 未能显示出对患者有益。抗胆碱能药物的试验效果不佳，耐受性也较差。肉毒杆菌毒素 A 显示出改善 APN 症状的效果。最近，包括美金刚和加巴喷丁的试验已经证明了对 APN 的成功抑制作用。DBS 等手术方式尚未显示出改善效果，尽管只有一份病例报告作为证据。眼-腭震颤是一种独特的后颅窝肿瘤表现，破坏了盖伦-莫拉雷三角。通过药物管理来控制症状的方法取得的成功有限，这归因于反应不佳和药物不耐受。DBS 等手术方式可能通过靶向齿状核-红核-橄榄束通路的不同步活动，在 OPT 治疗中发挥新兴作用。
