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Aims: Tremor is an involuntary, regularly repeated muscle contraction leading to rhythmic movement of parts of the body. Most tremors occur in the hands. Essential tremor is the most common form. Besides, many different cerebral and extracerebral disorders can produce tremor. In adults orolingual tremor is mainly observed in Parkinson's disease and drug-induced due to neuroleptic medication.
Patient and methods: A 7 year-old boy presented with tongue tremor existing for 1.5 years. Tremor could be voluntarily interrupted only for a moment and it stopped during sleep. Orolingual functions like speaking, chewing, swallowing and taste sensation were not impaired. Clinical examination showed an isolated tremor of the tongue and mouth base; cranial nerves and other pediatric neurologic examination remained normal. Broad diagnostic work-up including cranial MRI, EEG, muscle sonography, echocardiocraphy and ECG, pulmonary function tests, serum creatinine kinase and laboratory analysis for M. Wilson revealed normal results. However, a medication trial with levidopa/carbidopa (dosage 3.5mg/kg) did not improve the tremor.
Conclusion: An isolated tremor of tongue and mouth base in a neurologically unimpaired child is very rare. In such a case essential tremor is a diagnosis of exclusion. Therapeutic options for essential orolingual tremor may be medical treatment with beta blockers or topiramate.