Palatal myoclonus is a rare disorder described as separable from the general group of myoclonias as a clinical and antomical entity result from lesion involving the dentato-rubro-olivary pathway and the inferior olivary nucleus. This 21-year-old man was injured in a fall from the roof. On admission to the hospital, he had cerebral contusion and occipital bone fracture with other multiple trauma. On the eleventh day after the injury, he began showing rhythmic, 150/min, bilateral contraction of the palate. This movement disorder has hitherto been considered untreatable when idiopathic origin. But several reports describe improvement of palatal myoclonus during sleep or medical treatment. In this case, palatal myoclonus was absent during sleep and it responded well to oral administration of clonazepam. We report a case of palatal myoclonus which developed after trauma for the first time in Korea.
Administration, Oral ; Clonazepam ; Contusions ; Humans ; Korea ; Movement Disorders ; Multiple Trauma ; Myoclonus* ; Occipital Bone ; Olivary Nucleus ; Palate ; Young Adult

The treatment of pathologic aerophagia has rarely been discussed in the literature. In this retrospective study, the authors investigated the effects of clonazepam on the management of pathologic childhood aerophagia (PCA) with psychological stresses (PS), but not with mental retardation. Data from 22 consecutive PCA patients with PS (aged 2 to 10 yr), who had been followed up for over 1 yr, were reviewed. On the basis of videolaryngoscopic views, the authors observed that the pathology of aerophagia was the result of reflex-induced swallowing with paroxysmal openings of the upper esophageal sphincter due to unknown factors and also observed that these reflex-induced openings were subsided after intravenous low dose benzodiazepine administration. Hence, clonazepam was administered to treat paroxysmal openings in these PCA patients with PS. Remission positivity was defined as symptom-free for a consecutive 1 month within 6 months of treatment. The results of treatment in 22 PCA patients with PS were analyzed. A remission positive state was documented in 14.3% of PCA patients managed by reassurance, and in 66.7% of PCA patients treated with clonazepam (p=0.032). Thus, clonazepam may produce positive results in PCA with PS. Future studies by randomized and placebo-controlled trials are needed to confirm the favorable effect of clonazepam in PCA.
Treatment Outcome ; Stress, Psychological/*complications/*drug therapy ; Retrospective Studies ; Male ; Injections, Intravenous ; Humans ; Female ; Clonazepam/*administration & dosage ; Child, Preschool ; Child ; Anticonvulsants/administration & dosage ; Aerophagy/*complications/*prevention & control

OBJECTIVETo study the efficacy of levetiracetam (LEV) combined with short-term clonazepam (CZP) in the treatment of electrical status epilepticus during sleep (ESES) in children with benign childhood epilepsy with centrotemporal spikes (BECCT).

METHODSFifteen children (9 boys and 6 girls) diagnosed with BECCT with ESES, who had continuous spike-and-wave accounting for over 85% of the non-rapid eye movement sleep as monitored by 24-hours ambulatory EEG or 3-hours video EEG, were enrolled. The clinical manifestations and EEG characteristics of patients were retrospectively analyzed. These children received two months of CZP treatment in addition to oral LEV [20-40 mg/(kg·d)]. All patients were followed up for 6-18 months.

RESULTSThe 15 children were orally given LEV in the early stage, but showed no improvement when reexamined by EEG or had seizures during treatment. Then, they received LEV in combination with short-term CZP. Re-examinations at 1 and 6 months after treatment showed that 14 cases had significantly reduced discharge (only little discharge in the Rolandic area) or no discharge, as well as completely controlled seizure; one case had recurrent ESES and two epileptic seizures during follow-up. The recurrent case received the combination therapy again, and re-examinations 1 and 6 months later revealed normal EEG; no seizure occurred in the 8 months of follow-up.

CONCLUSIONSLEV combined with short-term CZP is effective and has few side effects in treating ESES syndrome among children with BECCT.

Anticonvulsants ; administration & dosage ; Child ; Child, Preschool ; Clonazepam ; administration & dosage ; Drug Therapy, Combination ; Electroencephalography ; Epilepsy, Rolandic ; drug therapy ; physiopathology ; Female ; Humans ; Male ; Piracetam ; administration & dosage ; analogs & derivatives ; Retrospective Studies ; Sleep ; physiology ; Status Epilepticus ; drug therapy ; physiopathology