Movement Disorder.\ zyxwvutsrqponmlk Vol. 12, No. 5, 1997, zyxwvutsrqpon pp. 794-797 zyxwvutsrqpo 0 1997 Movement Disorder Society Brief Report Action Palatal Tremor in a Patient with Primary Intestinal Lymphoma Antonio Gambardella, Mario Zappia, Paola Valentino, Umberto Aguglia, "Francesco Fera, *Kurt Pardatscher, and Aldo Quattrone zyxwv Institutes of Neurologj and *Neuroradiology. School of Medicine, University of Catanzaro, Catanzara, Italy Summary: We report the case of a 59-year-old man with pri- mary intestinal T-cell non-Hodgkin's lymphoma who devel- oped abnormal facial twitching synchronous with small palatal movements induced by attempts at speaking or swallowing. At rest, the electromyogram (EMG) showed no spontaneous mus- cular activity. Phonation triggered trains of synchronous,rhyth- mic EMG bursts at a frequency of 3-4 Hz lasting 10-20 s, with an average burst of zyxwvutsrq 150 ms, which simultaneously involved palatal, facial, and neck muscles bilaterally with left-sided pre- dominance. An enhanced blink reflex recovery curve was ob- served after stimulation of either side. Backaveraging electro- encephalographic study revealed no activity that was time locked with the jerks. Axial T2-weighted magnetic resonance imaging showed an increased signal intensity and bilateral en- largement of the inferior olives. No antineuronal-specific anti- bodies were found in the blood or in the cerebrospinal fluid. All of these clinical findings were consistent with a symptomatic palatal tremor (PT). Because it was triggered by activation of cranial muscles, we termed this movement disorder action PT. To our knowledge, this is the first report of symptomatic PT displaying these features Key Words: Action tremor- Lymphoma-Magnetic res 4 nance imaging-Inferior olive- Electroencephalogram-Electromyograph y . Palatal tremor (PT) (l), formerly called palatal myoc- lonus (2), is a rare involuntary movement disorder char- acterized by rhythmic contractions of the soft palate and occasional synchronous twitching of brainstem inner- vated muscles (1,2). PT encompasses two distinct clini- cal entities: essential PT and symptomatic PT (1,2). The latter has been associated with different brainstem or cerebellar lesions, including trauma, tumor, infection, multiple sclerosis, vascular lesion, and other symptom- atic etiologies (1,2). Typically, PT is a rhythmic, involuntary, ongoing movement, steady in its intensity and amplitude, which the patient may be unaware of (3). Exceptionally, PT may be disrupted by sleep (4) or even temporarily sup- pressed by phonation, swallowing, or other voluntary actions (5-7). Here we report the case of a patient who developed PT while he had a primary intestinal lymphoma. A remark- able feature was that PT was absent at rest and was triggered only by attempts at speaking or swallowing. CASE REPORT The patient, a 59-year-old right-handed man, with no family history of involuntary movements or other neu- rologic disorder, had been in good health until 2 years earlier, when he developed mild diarrhea and recurrent abdominal pain. The findings of a barium-enema exami- nation and a colonoscopic examination performed else- where had been normal. His symptoms resolved sponta- neously within a few months. After 1 year (that is, 6 months before admission), however, mild abdominal pain and diarrhea recurred. During the following months, A videotape accompanies this article. Received January 31, 1996; revision received June 25, 1996; ac- zyxwvuts I - the symptoms worsened, and the patient began to have Moreover, since the recurrence of intestinal symptoms, cepted August 18, 1996. Address correspondence and reprint requests to Prof. A. Quattrone at Cattedra di Neurologia, Policlinico Mater Domini, Via T. Campanella, evening fever (temperature, 37.50c) and lost weight. 88 I00 Catanzaro, Italy. 794