Objective: Palatal tremor(PT) is an extremly rare movement disorder, defined by rhythmic movements of the soft palate. PT is divided into two forms: essential PT(EPT) and symptomatic PT. In contrast to other movement disorders, PT rarely has a psychogenic etiology.

Background: A 22-year-old male patient presented with bilateral ear clicking for three months. The neurological examination was normal apart from rhythmic movements of pharyngeal muscles. These findings developed abruptly after emotional stress. While the patient initially had performed partial voluntary control over PT, he performed complete voluntary control two months later.

Methods: Detailed investigations including cranial MRI were normal. There was a history of substance abuse.

Results: Abrupt onset of tremor, spontaneous remissions, somatization in the past history, disappearance of extra neurological signs, decrease of tremor amplitude and variation of frequency during distraction, complete voluntury control and good response to placebo increase the doubt of a psychogenic etiology. Some features of psychogenic PT(PPT) like distractibility and partial vulontary control that can be seen in EPT. Although ear clicks are the common clinical manifestation in EPT, they may also seen in PPT.

Conclusions: PPT may be misdiagnosed as EPT if diagnostic criteria are not appplied.

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MDS Abstracts - https://www.mdsabstracts.org/abstract/psychogenic-palatal-tremor-a-case-report/