{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,2,3]],"date-time":"2026-02-03T10:59:43Z","timestamp":1770116383348,"version":"3.49.0"},"reference-count":48,"publisher":"Journal of Neurosurgery Publishing Group (JNSPG)","issue":"17","license":[{"start":{"date-parts":[[2025,4,28]],"date-time":"2025-04-28T00:00:00Z","timestamp":1745798400000},"content-version":"unspecified","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by-nc-nd\/4.0\/"}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["J Cosmet Laser Ther"],"published-print":{"date-parts":[[2025,4,28]]},"abstract":"\n BACKGROUND<\/jats:title>\n Posterior cranial fossa tumor resection can be complicated by a rare but potentially debilitating condition known as hypertrophic olivary degeneration (HOD). This condition is diagnosed using a high degree of clinical suspicion as well as T2\/FLAIR MRI findings of nonenhancing, hyperintense enlargement of the inferior olivary nucleus.<\/jats:p>\n <\/jats:sec>\n \n OBSERVATIONS<\/jats:title>\n The authors present a unique case of HOD in a 49-year-old female 4 months after resection of a low-grade pilocytic astrocytoma from the cerebellar vermis. The patient displayed classic signs associated with HOD, including palatal tremor, ocular nystagmus, and ocular myoclonus. Management will likely be challenging, and the patient was referred to movement disorder specialists to discuss potential treatment options.<\/jats:p>\n <\/jats:sec>\n \n LESSONS<\/jats:title>\n Few case reports of HOD after neurosurgical intervention in adults are available in the literature. In this work, the authors conducted a literature review of available data for 23 cases of HOD in adult patients after midline posterior cranial fossa tumor resection. The prognosis of symptomatic HOD is generally poor, as no standardized treatment regimen for these patients currently exists.<\/jats:p>\n \n https:\/\/thejns.org\/doi\/10.3171\/CASE25130<\/jats:ext-link>\n <\/jats:p>\n <\/jats:sec>","DOI":"10.3171\/case25130","type":"journal-article","created":{"date-parts":[[2025,4,28]],"date-time":"2025-04-28T20:14:19Z","timestamp":1745871259000},"source":"Crossref","is-referenced-by-count":0,"title":["Hypertrophic olivary degeneration after posterior cranial fossa tumor resection in adults: illustrative case"],"prefix":"10.3171","volume":"9","author":[{"ORCID":"https:\/\/orcid.org\/0009-0007-6926-1339","authenticated-orcid":true,"given":"Joshua M.","family":"Venegas","sequence":"first","affiliation":[{"name":"Department of Neurosurgery, Medical University of South Carolina, Charleston, South Carolina"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Aaron","family":"Miller","sequence":"additional","affiliation":[{"name":"Department of Neurosurgery, Medical University of South Carolina, Charleston, South Carolina"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Coulter","family":"Small","sequence":"additional","affiliation":[{"name":"Department of Neurosurgery, Medical University of South Carolina, Charleston, South Carolina"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Ben A.","family":"Strickland","sequence":"additional","affiliation":[{"name":"Department of Neurosurgery, Medical University of South Carolina, Charleston, South Carolina"}],"role":[{"role":"author","vocabulary":"crossref"}]}],"member":"1754","reference":[{"key":"bib1","series-title":"World Neurosurg","first-page":"e763","article-title":"Hypertrophic olivary degeneration: neurosurgical perspective and literature review","volume":"112","author":"Onen","year":"2018","unstructured":"Onen MRMoore KCikla UHypertrophic olivary degeneration: neurosurgical perspective and literature review. World Neurosurg. 2018;112:e763-e771."},{"key":"bib2","series-title":"Brain Res","first-page":"53","article-title":"Hypertrophic olivary degeneration: a comprehensive review focusing on etiology","volume":"1718","author":"Wang","year":"2019","unstructured":"Wang HWang YWang RHypertrophic olivary degeneration: a comprehensive review focusing on etiology. Brain Res. 2019;1718:53-63."},{"issue":"19","key":"bib3","series-title":"Neurology","first-page":"e199","article-title":"Teaching NeuroImages: hemorrhagic cavernoma with secondary development of hypertrophic olivary degeneration","volume":"80","author":"Crosbie","year":"2013","unstructured":"Crosbie IMcNally SBrennan PLooby S.Teaching NeuroImages: hemorrhagic cavernoma with secondary development of hypertrophic olivary degeneration. Neurology. 2013;80(19):e199-e200."},{"key":"bib4","series-title":"Parkinsonism Relat Disord","first-page":"36","article-title":"Hypertrophic olivary degeneration: a clinico-radiologic study","volume":"28","author":"Konno","year":"2016","unstructured":"Konno TBroderick DFTacik PCaviness JNWszolek ZK.Hypertrophic olivary degeneration: a clinico-radiologic study. Parkinsonism Relat Disord. 2016;28:36-40."},{"issue":"5","key":"bib5","series-title":"Childs Nerv Syst","first-page":"959","article-title":"Hypertrophic olivary degeneration with gadolinium enhancement after posterior fossa surgery in a child with medulloblastoma","volume":"30","author":"Nowak","year":"2014","unstructured":"Nowak JAlkonyi BRutkowski SHomola GAWarmuth-Metz M.Hypertrophic olivary degeneration with gadolinium enhancement after posterior fossa surgery in a child with medulloblastoma. Childs Nerv Syst. 2014;30(5):959-962."},{"issue":"2","key":"bib6","series-title":"J Neuroimaging","first-page":"289","article-title":"Frequency of bilateral hypertrophic olivary degeneration in a large retrospective cohort","volume":"25","author":"Carr","year":"2015","unstructured":"Carr CMHunt CHKaufmann TJKotsenas ALKrecke KNWood CP.Frequency of bilateral hypertrophic olivary degeneration in a large retrospective cohort. J Neuroimaging. 2015;25(2):289-295."},{"issue":"7","key":"bib7","series-title":"J Clin Neurosci","first-page":"1213","article-title":"Hypertrophic olivary degeneration secondary to pontine haemorrhage","volume":"22","author":"Wein","year":"2015","unstructured":"Wein SYan BGaillard F.Hypertrophic olivary degeneration secondary to pontine haemorrhage. J Clin Neurosci. 2015;22(7):1213-1214."},{"issue":"5","key":"bib8","series-title":"Radiol Med","first-page":"474","article-title":"MRI findings of olivary degeneration after surgery for posterior fossa tumours in children: incidence, time course and correlation with tumour grading","volume":"120","author":"Tartaglione","year":"2015","unstructured":"Tartaglione TIzzo GAlexandre AMRI findings of olivary degeneration after surgery for posterior fossa tumours in children: incidence, time course and correlation with tumour grading. Radiol Med. 2015;120(5):474-482."},{"issue":"1013","key":"bib9","series-title":"Br J Radiol","first-page":"511","article-title":"Hypertrophic olivary degeneration in children: four new cases and a review of the literature with an emphasis on the MRI findings","volume":"85","author":"Sanverdi","year":"2012","unstructured":"Sanverdi SEOguz KKHaliloglu G.Hypertrophic olivary degeneration in children: four new cases and a review of the literature with an emphasis on the MRI findings. Br J Radiol. 2012;85(1013):511-516."},{"issue":"4","key":"bib10","series-title":"Acta Radiol","first-page":"462","article-title":"Hypertrophic olivary degeneration after surgical resection of brain tumors","volume":"54","author":"Shinohara","year":"2013","unstructured":"Shinohara YKinoshita TKinoshita FKaminou TWatanabe TOgawa T.Hypertrophic olivary degeneration after surgical resection of brain tumors. Acta Radiol. 2013;54(4):462-466."},{"issue":"2","key":"bib11","series-title":"Cancers","article-title":"A paravermal trans-cerebellar approach to the posterior fossa tumor causes hypertrophic olivary degeneration by dentate nucleus injury","volume":"13","author":"Schaller-Paule","year":"2021","unstructured":"Schaller-Paule MABaumgarten PSeifert VA paravermal trans-cerebellar approach to the posterior fossa tumor causes hypertrophic olivary degeneration by dentate nucleus injury. Cancers. 2021;13(2):258."},{"issue":"3","key":"bib12","series-title":"J Neurooncol","first-page":"341","article-title":"Hypertrophic olivary degeneration after resection of a cerebellar tumor","volume":"87","author":"Akar","year":"2008","unstructured":"Akar SDrappatz JHsu LBlinder RABlack PMKesari S.Hypertrophic olivary degeneration after resection of a cerebellar tumor. J Neurooncol. 2008;87(3):341-345."},{"issue":"5","key":"bib13","series-title":"Clin Imaging","first-page":"787","article-title":"Hypertrophic olivary degeneration resulting from posterior fossa masses and their treatments","volume":"39","author":"Hirano","year":"2015","unstructured":"Hirano MHatzoglou VKarimi SYoung RJ.Hypertrophic olivary degeneration resulting from posterior fossa masses and their treatments. Clin Imaging. 2015;39(5):787-790."},{"key":"bib14","series-title":"World Neurosurg","first-page":"71","article-title":"Surgical management of isolated fourth ventricular hydrocephalus associated with injury to the Guillain-Mollaret triangle","volume":"122","author":"Khayat","year":"2019","unstructured":"Khayat HAAl-Saadi TPanet-Raymond VDiaz RJ.Surgical management of isolated fourth ventricular hydrocephalus associated with injury to the Guillain-Mollaret triangle. World Neurosurg. 2019;122:71-76."},{"issue":"2","key":"bib15","series-title":"Neuroradiol J","first-page":"182","article-title":"Bilateral surgical damage of the central tegmental tract resulting in bilateral hypertrophic olivary degeneration: an MRI case report","volume":"31","author":"Lana","year":"2018","unstructured":"Lana SGanazzoli CCrisi G.Bilateral surgical damage of the central tegmental tract resulting in bilateral hypertrophic olivary degeneration: an MRI case report. Neuroradiol J. 2018;31(2):182-185."},{"key":"bib16","series-title":"World Neurosurg","first-page":"18","article-title":"Hypertrophic olivary degeneration postoperatively following pilocytic astrocytoma resection","volume":"165","author":"McDonald","year":"2022","unstructured":"McDonald MFRao GMandel JJ.Hypertrophic olivary degeneration postoperatively following pilocytic astrocytoma resection. World Neurosurg. 2022;165:18-19."},{"issue":"12","key":"bib17","series-title":"J Clin Med","first-page":"2222","article-title":"Delayed occurrence of hypertrophic olivary degeneration after therapy of posterior fossa tumors: a single institution retrospective analysis","volume":"8","author":"Schaller-Paule","year":"2019","unstructured":"Schaller-Paule MAFoerch CKluge SDelayed occurrence of hypertrophic olivary degeneration after therapy of posterior fossa tumors: a single institution retrospective analysis. J Clin Med. 2019;8(12):2222."},{"issue":"994","key":"bib18","series-title":"Br J Radiol","first-page":"e211","article-title":"Bilateral hypertrophic olivary degeneration following surgical resection of a posterior fossa epidermoid cyst","volume":"83","author":"Vaidhyanath","year":"2010","unstructured":"Vaidhyanath RThomas AMessios N.Bilateral hypertrophic olivary degeneration following surgical resection of a posterior fossa epidermoid cyst. Br J Radiol. 2010;83(994):e211-e215."},{"issue":"3","key":"bib19","series-title":"Acta Neurochir","first-page":"469","article-title":"Hypertrophic olivary degeneration following surgical resection or gamma knife radiosurgery of brainstem cavernous malformations: an 11-case series and a review of literature","volume":"155","author":"Yun","year":"2013","unstructured":"Yun JHAhn JSPark JCKwon DHKwun BDKim CJ.Hypertrophic olivary degeneration following surgical resection or gamma knife radiosurgery of brainstem cavernous malformations: an 11-case series and a review of literature. Acta Neurochir. 2013;155(3):469-476."},{"key":"bib20","series-title":"Front Neurol","first-page":"302","article-title":"Hypertrophic olivary degeneration and palatal or oculopalatal tremor","volume":"8","author":"Tilikete","year":"2017","unstructured":"Tilikete CDesestret V.Hypertrophic olivary degeneration and palatal or oculopalatal tremor. Front Neurol. 2017;8:302."},{"issue":"6","key":"bib21","series-title":"Ann Neurol","first-page":"818","article-title":"A double-blind controlled study of gabapentin and baclofen as treatment for acquired nystagmus","volume":"41","author":"Averbuch-Heller","year":"1997","unstructured":"Averbuch-Heller LTusa RJFuhry LA double-blind controlled study of gabapentin and baclofen as treatment for acquired nystagmus. Ann Neurol. 1997;41(6):818-825."},{"issue":"3","key":"bib22","series-title":"J Neurol","first-page":"322","article-title":"Acquired pendular nystagmus in multiple sclerosis: an examiner-blind cross-over treatment study of memantine and gabapentin","volume":"257","author":"Starck","year":"2010","unstructured":"Starck MAlbrecht HP\u00f6llmann WDieterich MStraube A.Acquired pendular nystagmus in multiple sclerosis: an examiner-blind cross-over treatment study of memantine and gabapentin. J Neurol. 2010;257(3):322-327."},{"issue":"3","key":"bib23","series-title":"Egypt J Rad Nucl Med","first-page":"1019","article-title":"MRI and neurological presentation of hypertrophic olivary degeneration","volume":"47","author":"Elnekiedy","year":"2016","unstructured":"Elnekiedy ANaguib NHamed WMRI and neurological presentation of hypertrophic olivary degeneration. Egypt J Rad Nucl Med. 2016;47(3):1019-1029."},{"key":"bib24","series-title":"Case Rep Otolaryngol","first-page":"231505","article-title":"Treatment of palatal myoclonus with botulinum toxin injection","volume":"2013","author":"Anis","year":"2013","unstructured":"Anis MMPollak N.Treatment of palatal myoclonus with botulinum toxin injection. Case Rep Otolaryngol. 2013;2013:231505."},{"key":"bib1","series-title":"World Neurosurg","first-page":"e763","article-title":"Hypertrophic olivary degeneration: neurosurgical perspective and literature review","volume":"112","author":"Onen","year":"2018","unstructured":"Onen MRMoore KCikla UHypertrophic olivary degeneration: neurosurgical perspective and literature review. World Neurosurg. 2018;112:e763-e771."},{"key":"bib2","series-title":"Brain Res","first-page":"53","article-title":"Hypertrophic olivary degeneration: a comprehensive review focusing on etiology","volume":"1718","author":"Wang","year":"2019","unstructured":"Wang HWang YWang RHypertrophic olivary degeneration: a comprehensive review focusing on etiology. Brain Res. 2019;1718:53-63."},{"issue":"19","key":"bib3","series-title":"Neurology","first-page":"e199","article-title":"Teaching NeuroImages: hemorrhagic cavernoma with secondary development of hypertrophic olivary degeneration","volume":"80","author":"Crosbie","year":"2013","unstructured":"Crosbie IMcNally SBrennan PLooby S.Teaching NeuroImages: hemorrhagic cavernoma with secondary development of hypertrophic olivary degeneration. Neurology. 2013;80(19):e199-e200."},{"key":"bib4","series-title":"Parkinsonism Relat Disord","first-page":"36","article-title":"Hypertrophic olivary degeneration: a clinico-radiologic study","volume":"28","author":"Konno","year":"2016","unstructured":"Konno TBroderick DFTacik PCaviness JNWszolek ZK.Hypertrophic olivary degeneration: a clinico-radiologic study. Parkinsonism Relat Disord. 2016;28:36-40."},{"issue":"5","key":"bib5","series-title":"Childs Nerv Syst","first-page":"959","article-title":"Hypertrophic olivary degeneration with gadolinium enhancement after posterior fossa surgery in a child with medulloblastoma","volume":"30","author":"Nowak","year":"2014","unstructured":"Nowak JAlkonyi BRutkowski SHomola GAWarmuth-Metz M.Hypertrophic olivary degeneration with gadolinium enhancement after posterior fossa surgery in a child with medulloblastoma. Childs Nerv Syst. 2014;30(5):959-962."},{"issue":"2","key":"bib6","series-title":"J Neuroimaging","first-page":"289","article-title":"Frequency of bilateral hypertrophic olivary degeneration in a large retrospective cohort","volume":"25","author":"Carr","year":"2015","unstructured":"Carr CMHunt CHKaufmann TJKotsenas ALKrecke KNWood CP.Frequency of bilateral hypertrophic olivary degeneration in a large retrospective cohort. J Neuroimaging. 2015;25(2):289-295."},{"issue":"7","key":"bib7","series-title":"J Clin Neurosci","first-page":"1213","article-title":"Hypertrophic olivary degeneration secondary to pontine haemorrhage","volume":"22","author":"Wein","year":"2015","unstructured":"Wein SYan BGaillard F.Hypertrophic olivary degeneration secondary to pontine haemorrhage. J Clin Neurosci. 2015;22(7):1213-1214."},{"issue":"5","key":"bib8","series-title":"Radiol Med","first-page":"474","article-title":"MRI findings of olivary degeneration after surgery for posterior fossa tumours in children: incidence, time course and correlation with tumour grading","volume":"120","author":"Tartaglione","year":"2015","unstructured":"Tartaglione TIzzo GAlexandre AMRI findings of olivary degeneration after surgery for posterior fossa tumours in children: incidence, time course and correlation with tumour grading. Radiol Med. 2015;120(5):474-482."},{"issue":"1013","key":"bib9","series-title":"Br J Radiol","first-page":"511","article-title":"Hypertrophic olivary degeneration in children: four new cases and a review of the literature with an emphasis on the MRI findings","volume":"85","author":"Sanverdi","year":"2012","unstructured":"Sanverdi SEOguz KKHaliloglu G.Hypertrophic olivary degeneration in children: four new cases and a review of the literature with an emphasis on the MRI findings. Br J Radiol. 2012;85(1013):511-516."},{"issue":"4","key":"bib10","series-title":"Acta Radiol","first-page":"462","article-title":"Hypertrophic olivary degeneration after surgical resection of brain tumors","volume":"54","author":"Shinohara","year":"2013","unstructured":"Shinohara YKinoshita TKinoshita FKaminou TWatanabe TOgawa T.Hypertrophic olivary degeneration after surgical resection of brain tumors. Acta Radiol. 2013;54(4):462-466."},{"issue":"2","key":"bib11","series-title":"Cancers","article-title":"A paravermal trans-cerebellar approach to the posterior fossa tumor causes hypertrophic olivary degeneration by dentate nucleus injury","volume":"13","author":"Schaller-Paule","year":"2021","unstructured":"Schaller-Paule MABaumgarten PSeifert VA paravermal trans-cerebellar approach to the posterior fossa tumor causes hypertrophic olivary degeneration by dentate nucleus injury. Cancers. 2021;13(2):258."},{"issue":"3","key":"bib12","series-title":"J Neurooncol","first-page":"341","article-title":"Hypertrophic olivary degeneration after resection of a cerebellar tumor","volume":"87","author":"Akar","year":"2008","unstructured":"Akar SDrappatz JHsu LBlinder RABlack PMKesari S.Hypertrophic olivary degeneration after resection of a cerebellar tumor. J Neurooncol. 2008;87(3):341-345."},{"issue":"5","key":"bib13","series-title":"Clin Imaging","first-page":"787","article-title":"Hypertrophic olivary degeneration resulting from posterior fossa masses and their treatments","volume":"39","author":"Hirano","year":"2015","unstructured":"Hirano MHatzoglou VKarimi SYoung RJ.Hypertrophic olivary degeneration resulting from posterior fossa masses and their treatments. Clin Imaging. 2015;39(5):787-790."},{"key":"bib14","series-title":"World Neurosurg","first-page":"71","article-title":"Surgical management of isolated fourth ventricular hydrocephalus associated with injury to the Guillain-Mollaret triangle","volume":"122","author":"Khayat","year":"2019","unstructured":"Khayat HAAl-Saadi TPanet-Raymond VDiaz RJ.Surgical management of isolated fourth ventricular hydrocephalus associated with injury to the Guillain-Mollaret triangle. World Neurosurg. 2019;122:71-76."},{"issue":"2","key":"bib15","series-title":"Neuroradiol J","first-page":"182","article-title":"Bilateral surgical damage of the central tegmental tract resulting in bilateral hypertrophic olivary degeneration: an MRI case report","volume":"31","author":"Lana","year":"2018","unstructured":"Lana SGanazzoli CCrisi G.Bilateral surgical damage of the central tegmental tract resulting in bilateral hypertrophic olivary degeneration: an MRI case report. Neuroradiol J. 2018;31(2):182-185."},{"key":"bib16","series-title":"World Neurosurg","first-page":"18","article-title":"Hypertrophic olivary degeneration postoperatively following pilocytic astrocytoma resection","volume":"165","author":"McDonald","year":"2022","unstructured":"McDonald MFRao GMandel JJ.Hypertrophic olivary degeneration postoperatively following pilocytic astrocytoma resection. World Neurosurg. 2022;165:18-19."},{"issue":"12","key":"bib17","series-title":"J Clin Med","first-page":"2222","article-title":"Delayed occurrence of hypertrophic olivary degeneration after therapy of posterior fossa tumors: a single institution retrospective analysis","volume":"8","author":"Schaller-Paule","year":"2019","unstructured":"Schaller-Paule MAFoerch CKluge SDelayed occurrence of hypertrophic olivary degeneration after therapy of posterior fossa tumors: a single institution retrospective analysis. J Clin Med. 2019;8(12):2222."},{"issue":"994","key":"bib18","series-title":"Br J Radiol","first-page":"e211","article-title":"Bilateral hypertrophic olivary degeneration following surgical resection of a posterior fossa epidermoid cyst","volume":"83","author":"Vaidhyanath","year":"2010","unstructured":"Vaidhyanath RThomas AMessios N.Bilateral hypertrophic olivary degeneration following surgical resection of a posterior fossa epidermoid cyst. Br J Radiol. 2010;83(994):e211-e215."},{"issue":"3","key":"bib19","series-title":"Acta Neurochir","first-page":"469","article-title":"Hypertrophic olivary degeneration following surgical resection or gamma knife radiosurgery of brainstem cavernous malformations: an 11-case series and a review of literature","volume":"155","author":"Yun","year":"2013","unstructured":"Yun JHAhn JSPark JCKwon DHKwun BDKim CJ.Hypertrophic olivary degeneration following surgical resection or gamma knife radiosurgery of brainstem cavernous malformations: an 11-case series and a review of literature. Acta Neurochir. 2013;155(3):469-476."},{"key":"bib20","series-title":"Front Neurol","first-page":"302","article-title":"Hypertrophic olivary degeneration and palatal or oculopalatal tremor","volume":"8","author":"Tilikete","year":"2017","unstructured":"Tilikete CDesestret V.Hypertrophic olivary degeneration and palatal or oculopalatal tremor. Front Neurol. 2017;8:302."},{"issue":"6","key":"bib21","series-title":"Ann Neurol","first-page":"818","article-title":"A double-blind controlled study of gabapentin and baclofen as treatment for acquired nystagmus","volume":"41","author":"Averbuch-Heller","year":"1997","unstructured":"Averbuch-Heller LTusa RJFuhry LA double-blind controlled study of gabapentin and baclofen as treatment for acquired nystagmus. Ann Neurol. 1997;41(6):818-825."},{"issue":"3","key":"bib22","series-title":"J Neurol","first-page":"322","article-title":"Acquired pendular nystagmus in multiple sclerosis: an examiner-blind cross-over treatment study of memantine and gabapentin","volume":"257","author":"Starck","year":"2010","unstructured":"Starck MAlbrecht HP\u00f6llmann WDieterich MStraube A.Acquired pendular nystagmus in multiple sclerosis: an examiner-blind cross-over treatment study of memantine and gabapentin. J Neurol. 2010;257(3):322-327."},{"issue":"3","key":"bib23","series-title":"Egypt J Rad Nucl Med","first-page":"1019","article-title":"MRI and neurological presentation of hypertrophic olivary degeneration","volume":"47","author":"Elnekiedy","year":"2016","unstructured":"Elnekiedy ANaguib NHamed WMRI and neurological presentation of hypertrophic olivary degeneration. Egypt J Rad Nucl Med. 2016;47(3):1019-1029."},{"key":"bib24","series-title":"Case Rep Otolaryngol","first-page":"231505","article-title":"Treatment of palatal myoclonus with botulinum toxin injection","volume":"2013","author":"Anis","year":"2013","unstructured":"Anis MMPollak N.Treatment of palatal myoclonus with botulinum toxin injection. 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