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Orthostatic Jaw Tremor, a Diagnostic Challenge for Neurologists
Clinical Neurology and Neuroscience
Volume 4, Issue 3, September 2020, Pages: 61-65
Received: Jun. 27, 2020; Accepted: Jul. 22, 2020; Published: Aug. 31, 2020
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Rafaela Magalhães Britto Pacheco de Moraes, Department of Neurology, Hospital Santa Marcelina, São Paulo, Brazil
Fernando José de Souza, Department of Neurology, Hospital Santa Marcelina, São Paulo, Brazil
João Fellipe Santos Tatsch, Department of Neurology, Hospital Santa Marcelina, São Paulo, Brazil
Livia Souza Santos, Department of Neuropsychiatry, Hospital Santa Marcelina, São Paulo, Brazil
José Furtado Alves Junior, Department of Neurophysiology, Hospital Santa Marcelina, São Paulo, Brazil
Maria Sheila Guimarães Rocha, Department of Neurology, Hospital Santa Marcelina, São Paulo, Brazil
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Jaw tremor is usually associated with tremor or other abnormal involuntary movements affecting additional body parts, but isolated jaw tremor is a rare clinical presentation. A 40-year-old man presented with history of paroxysmal jaw tremor for 3 years with no other neurological symptoms, psychiatric conditions, or a family history of neurological disorders. The tremor occurred only in the resting jaw position, with 10 episodes per day on an average, and lasted from 10 minutes to hours. It disappeared with any voluntary activation of the masseter muscle and did not change (in amplitude or frequency) with distraction maneuvers. The remainder of neurologic examination was unremarkable. The patient underwent extensive testing, including contrast-enhanced brain magnetic resonance imaging, blood tests and neuropsychiatric evaluation by two different neuropsychiatrists which failed to reveal the underlying cause. The needle electromyography examination revealed involuntary, intermittent, and synchronized muscular contractions in both masseter muscles, at a frequency of 13 to 14 Hz. No changes were discovered in the other muscles. He was treated with propranolol, primidone, valproic acid, diazepam, and amitriptyline, but the response was not significant. Injection of 25 units of botulinum toxin type A in the masseter muscle on both sides of the fac was effective five days after the injection. No adverse effects or masseter weakness were observed.
Paroxysmal Isolated Jaw Tremor, Primary Orthostatic Tremor, Botulinum Toxin
To cite this article
Rafaela Magalhães Britto Pacheco de Moraes, Fernando José de Souza, João Fellipe Santos Tatsch, Livia Souza Santos, José Furtado Alves Junior, Maria Sheila Guimarães Rocha, Orthostatic Jaw Tremor, a Diagnostic Challenge for Neurologists, Clinical Neurology and Neuroscience. Vol. 4, No. 3, 2020, pp. 61-65. doi: 10.11648/j.cnn.20200403.14
Copyright © 2020 Authors retain the copyright of this article.
This article is an open access article distributed under the Creative Commons Attribution License ( which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.
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