LETTER TO EDITOR
|Year : 2020 | Volume
| Issue : 1 | Page : 66
Hereditary chin trembling
Department of Physiotherapy and Rehabilitation, Hasan Kalyoncu University, School of Health Sciences, Gaziantep, Turkey; Department of Pediatric Neurology, Medical Park Hospital, Gaziantep, Turkey
|Date of Submission||13-Sep-2018|
|Date of Decision||11-Nov-2019|
|Date of Acceptance||18-Nov-2019|
|Date of Web Publication||19-Mar-2020|
Dr. Sedat Isikay
Department of Pediatrics, Institute of Health Sciences, Hasan Kalyoncu University, 27000, Gaziantep.
Source of Support: None, Conflict of Interest: None
|How to cite this article:|
Isikay S. Hereditary chin trembling. J Pediatr Neurosci 2020;15:66
A 3-year-old-boy was presented with involuntary, intermittent trembling of the chin noted since his early infancy [Video 1]. The initiation or suppression of these movements was involuntarily, and they were lessening at sleep. No abnormal movement of jaw, face, head, or any other body part was noted. No functional or social impairment was reported. He was the first and the only child of non-consanguineous parents. Physical examination, neuroimaging, and electroencephalography were unremarkable. Intermittent bursts of motor units firing consistent with muscle spasm were determined in electromyography. Motor nerve conduction velocities and F-wave latencies were normal. Botulinum toxin (50 units) was injected into the mentalis muscles. Within 2 days, both mentalis muscles ultimately paralyzed and trembling stopped.
Chin trembling or geniospasm is an extremely rare neurologically benign movement disorder, caused by continuous or intermittent tremulous activity of the mentalis muscle. It may be familial (autosomal-dominant) or sporadic. It is characterized by paroxysmal, rhythmic, up-and-down movements of the chin and/or lower lip with episodes lasting from seconds to hours. Episodes may occur spontaneously or be precipitated by stress and emotion. These typically become apparent in infancy or in early life, and the episodes tend to reduce in frequency/intensity with advancing age. Impairments include social embarrassment and interference with speech, feeding, or sleep. Electrophysiological studies have suggested these to be a form of subcortical myoclonus, and “hereditary chin myoclonus” has been proposed to be a better term to describe these movements. Treatment is usually not required; benzodiazepines, haloperidol, phenytoin, and botulinum toxin have been tried in desperate situations with limited success. Regular botulinum toxin injections to the mentalis muscle have been effective in the treatment of hereditary geniospasm.,
We report an extremely rare idiopathic case occurring in a child. It is important to rule out other causes such as essential tremor, palatal tremor, and facial myokymia. Botulinum toxin injection directly to the muscle may help to alleviate the symptoms. The clinical and electrophysiological features may help in differentiation.
Declaration of patient consent
The authors certify that they have obtained all appropriate patient consent forms. In the form the patient has given his consent for his images and other clinical information to be reported in the journal. The patients understand that their names and initials will not be published and due efforts will be made to conceal their identity, but anonymity cannot be guaranteed.
Financial support and sponsorship
Conflicts of interest
There are no conflicts of interest.
| References|| |
Danek A. Geniospasm: hereditary chin trembling. Mov Disord 1993;8:335-8.
Grimes DA, Han F, Bulman D, Nicolson ML, Suchowersky O. Hereditary chin trembling: a new family with exclusion of the chromosome 9q13-q21 locus. Mov Disord 2002;17:1390-2.