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Subject: Palatal myoclonus
Dead Dr. Levine.
I read your article about the typewriter tinnitus you sent few days ago with such impression. I have a patient and would like to have your advice.
There was a 16 year old boy who had been taking evetiracetam 500 mg bid due to complex partial seizure.
He had had an objective mechanical tinnitus: hand-watch-clicking sound continually about 0.5 Hz, with some silent period. The sound was heard by other people if one located one's ear near the patient's left ear. The tinnitus continued while sleeping.
His soft palate, phyarynx and the base of his mouth showed jerky movement synchronously to the tinnitus.
I made a diagnosis of "palatal myoclonus". Medication tried for a month were as follows.
carbamazepin 200 mg bid for 14 days, then clonazepam 0.5 mg bid and flunarizine 5mg bid for 7 days, then clonazepam 0.5 mg bid and Na hydrogen divalproate 200mg bid,
==> trihexyphenidyl 4 mg tid was added on
==> valproic acid 300mg bid was added on.
Those medication did not work at all.
Please give a comment.
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Dear Dr. Han:
This appears to be a focal motor seizure and should be evaluated and treated by epileptologists.
Does the EEG correspond to his focal movements that were apparent on your attached video?
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Typewriter Tinnitus
Two medications,alprazolam and cyclandelate, have been shown in randomized clinical trials to slightly reduce tinnitus loudness.
On the other hand anecdotes describe single individuals in whom a medication has completely suppressed their tinnitus. These medications include carbamazepine, clonazepam, lorazepam, diazepam, scopolamine, risperdal, fluoxitene, and paroxitene, but none of these medications have been shown to suppress tinnitus in multiple individuals with any consistency or for any well-characterized group of tinnitus subjects.
baclofen.
Furthermore it extends the findings of Ryu et al. [3] by suggesting that the high pitch continuous tinnitus associated with vascular compression is not carbamazepine responsive, whereas, typewriter tinnitus is carbamazepine responsive.
3 Ryu H, Yamamoto S, Sugiyama K, Uemura K, Nozue M: Neurovascular decompression of the eighth cranial nerve in patients with hemifacial spasm and incidental tinnitus: an alternative way to study tinnitus. J Neurosurg 1998;88:232–236.