title: Oculopalatal tremor:  current concepts and new observations.
abstract: OBJECTIVE
  Oculopalatal tremor (OPT) is an acquired disorder resulting from the interruption of a specific brainstem circuitry, the dentato-rubro-olivary pathway or Guillain-Mollaret triangle. The recent literature on OPT and olivary hypertrophy was reviewed with specific interest regarding causes, diagnostic procedures, physiopathology and therapies.
  
  
  RESULTS
  OPT is associated with inferior olivary hypertrophy, and recent findings have provided a better understanding of its intimate mechanisms. A dual-mechanism model, combining an oscillator (inferior olive) and a modulator/amplifier (cerebellum), best explains the development of OPT. Electrotonic coupling and specific Ca channels contribute to oscillations of inferior olivary nucleus neurons in OPT. Improvement of visual symptoms can be achieved with oral gabapentin or memantine.
  
  
  CONCLUSIONS
  Both the neuronal circuitry and the physiopathology of OPT are now better understood. This opens up an era of specific therapy for this rare cause of disabling oscillopsia.
authors.affiliation: Hôpital Ophtalmique Jules Gonin, Neuro-Ophthalmology Unit, Lausanne, Switzerland. francois.borruat@fa2.ch
authors.forename: François-Xavier
authors.initials: FX
authors.lastname: Borruat
mesh_terms: D020520:Brain Infarction / Q000150:complications* / Q000473:pathology / Q000628:therapy; D001933:Brain Stem / Q000473:pathology; D002531:Cerebellum / Q000473:pathology; D005133:Eye Movements / Q000502:physiology*; D006801:Humans; D009207:Myoclonus / Q000150:complications* / Q000473:pathology / Q000628:therapy; D009434:Neural Pathways / Q000473:pathology / Q000502:physiology; D059906:Neuroimaging; D009847:Olivary Nucleus / Q000473:pathology; D014202:Tremor / Q000150:complications* / Q000473:pathology / Q000628:therapy