Dr. John Lieurance can you explain what the balloons do? I have tried many of the “conventional” methods for treating this. Next is botox, if that doesn’t work I am interested in trying FCR.
Thanks for asking. I’m still not 100% sure what the primary action the balloons is having for PM or that its multiple. My theory’s are that it could be mechanical see picture below as the manipulation the balloon makes is so close to the action of the the soft palate (also known as velum or muscular palate).
The following are the muscles that can be involved in Palatal Myoclonus.
- Tensor veli palatini, which is involved in swallowing
- Palatoglossus, involved in swallowing
- Palatopharyngeus, involved in breathing
- Levator veli palatini, involved in swallowing
- Musculus uvulae, which moves the uvula
Notice above the proximity of the nasal cavity to the muscles of the palate/velum. Next look below and see the cranial bones such as the palatine bone, vomer and sphenoid. The vomer is midline nd is not depicted in the second picture but is very important and is manipulated with FCR.
The second theory is that it’s neurological through the trigeminal nucleus and that the inflation is somehow interrupting the windup in the inferior olivary nucleus. Since the sinus’ are innervated through the trigeminal nucleus. The soft palate muscles are innervated by the vagus nerve, with the exception of the tensor veli palatini. The tensor veli palatini is innervated by the mandibular division of the trigeminal nerve. Somatosensory Trigeminal Projections to the Inferior Olive, Cerebellum and other Precerebellar Nuclei. This then corrects the dentato-rubro-olivary pathway that is dysfunctional in Palatal Myoclonus.
To date I have treated 26 cases of palatal myoclonus and have seen more success with these cases than failure. Most cases also have head pressure along with the “clicking” from the myoclonus pulling on the eustachian tube to the inner ear. I have found the head pressure almost always goes away with endo-nasal balloon adjusting (FCR) and the myoclonus has been relieved by the endo-nasal balloons on some cases but generally these cases also require specific activation of the brain described as functional neurological exercises. These exercises are based on a detailed neurological evaluation and also sacciometry testing. I also use Glutathione nebulized (GlutaGenisis) and PEMF of the brain to support the brain with it’s neuroplasticity (healing). Many cases have had the 4 day series and had complete resolution of PM. It should be important to note that some cases required follow up treatment. I generally see these cases for a 4 day course of care. Some cases require follow series. I have seen some cases receive incremental improvements in the symptoms of palatal myoclonus. I