Essential palatal myoclonus (EPM), also known as palatal tremor, is an infrequent neuro-otologic disorder manifesting with symmetrical rhythmic contractions of the soft palate muscles.1

We present the case of a male adolescent aged 15 years who presented to the emergency department with continuous rhythmic spasms of the soft palate and uvula with onset 24h prior, accompanied by perception of a recurrent clicking noise that caused significant discomfort to the patient, to the point that it precluded sleep (Appendix B video). These complaints were associated with fever, cough and nasal discharge, and the patient received a diagnosis of uncomplicated cold. At the emergency department, he was given a single dose of diazepam orally, which achieved complete resolution of the tremor. Two months later, the patient returned to the department with a new episode of similar characteristics, also in the context of a cold.

The diagnosis of EPM is clinical, although it requires ruling out secondary palatal myoclonus (which is less frequent in the paediatric age group) due to trauma, tumours, ischaemia, infection or demyelinating disorders. Essential palatal myoclonus may resolve spontaneously or with the use of a variety of treatments, such as benzodiazepines, carbamazepine, valproic acid or injections of botulinum toxin.2,3