A Multi-Institutional Case Series of Palato-Laryngeal Myoclonus: A Study in Advanced Neurolaryngology

Background: Palato-laryngeal myoclonus (PLM) is a rare hyperfunctional movement disorder that can involve multiple intrinsic and extrinsic muscles of the laryngopharynx.Myoclonus is defined as a sequence of repeated, brief, often nonrhythmic jerks because of sudden involuntary contraction or relaxation of one or more muscles.PLM can be associated with cerebrovascular accidents and neurologic injury.Methods: We conducted retrospective medical record reviews across multiple institutions to identify patients with PLM during the period 2015 through 2024.Patients were excluded if they did not have features of laryngeal myoclonus on flexible laryngoscopy.Results: We present 12 cases of PLM and describe symptomatology, examination and flexible laryngoscopy findings, imaging (if performed), treatment, and response to treatment.We also provide a review of the neuropathophysiology of this condition.Conclusion: Patients with PLM present with a wide variety of complaints including dysphagia, shortness of breath, dysphonia with voice breaks, and vocal tremor, in addition to the well-described palatal features of ear clicking and palatal spasms.No curative treatment is available for this condition, but treatments for symptomatic control include levetiracetam and other antiepileptic medications, as well as botulinum toxin type A that has been used to reduce symptoms.Further investigation is needed regarding effective management of PLM.