Oculopalatal Tremor: A Narrative Review of Pathophysiology, Clinical Presentation, and Management Strategy

Abstract

Oculopalatal tremor (OPT) is a complex neurological disorder characterized by acquired oscillatory nystagmus synchronized with tremors of the soft palate and other muscles. The article discusses the pathology, clinical manifestations, and diagnostic methods of OPT. A comprehensive literature search was conducted in PubMed and Google Scholar using keywords and relevant articles were studied and analysis was done. Vertical pendular nystagmus is the hallmark, while other muscles such as the neck, head, larynx, and diaphragm may be affected. The pathophysiology is due to lesions of the Guillain–Mollaret triangle (GMT), which causes hypertrophy of the inferior olivary. Neuroimaging reveals hypertrophy of the inferior olivary medulla, which aids in diagnosis. Drug treatments such as gabapentin and memantine can reduce nystagmus, although the visual quality may not permanently improve. The study explores the complexity of the pathophysiology and clinical presentation of OPT. New treatments that target abnormal neuronal connections with drugs such as quinine or mefloquine are being investigated. The potential of deep brain stimulation (DBS) remains uncertain, with promising aspects but limited efficacy. A synergy of technology and treatment is proposed to advance OPT treatment. Future studies will aim to clarify the nuances of responses to OPT and may include a comparative study of medication and DBS. OPT is mainly caused by a disruption in GMT/dentato-rubro-olivary pathway, presenting with tremor, and nystagmus is diagnosed with magnetic resonance imaging. Gabapentin and memantine have proved to be effective in improving the condition except for visual changes.

Keywords

• inferior olivary hypertrophy
• nystagmus
• oculopalatal tremor
• oscillopsia
• pathophysiology
• tremor