We describe two patients with swallowing disorders and palatal myoclonus. Case 1: A 54-year-old woman developed difficulty swallowing after a right cerebellar hemorrhage. Physical examination disclosed palatal myoclonus. Videofluoroscopy indicated a delayed swallowing reflex and a decreased range of motion of the tongue. Poor coordination of the bulbar muscles was also noted. A feeding gastrostomy was performed. Thermal stimulation and active ROM exercises for the cheek and tongue were carried out as rehabilitation, and drug therapy, including trihexyphenidyl and L-dopa/carbidopa, reduced the palatal myoclonus. The patient's swallowing reflex and voluntary tongue movements normalized with rehabilitation, until a regular diet could be taken orally. Case 2: A 77-year-old man presented with a swallowing disorder after bilateral cerebellar infarction. Physical examination demonstrated palatal myoclonus. The swallowing disorder was caused by a delayed swallowing reflex and decreased range of motion, strength, and coordination of the tongue. A semi-soft diet was initiated. Thermal stimulation, dry swallow exercises, and active ROM exercises for the cheek and tongue were carried out as rehabilitation. Drug therapy with L-dopa/carbidopa reduced the patient's myoclonus and his swallowing reflex and tongue function improved with rehabilitation. Finally, the patient's semi-soft diet was changed to soft. To our knowledge, this is the first report indicating the beneficial effect of rehabilitation and drug therapy on swallowing disorders with palatal myoclonus.
