When it comes to botulinum toxin, children and adults are not the same: multimuscle option for children with cerebral palsy.

to be palatopharyngeal myoclonus/tremor and posited a direct relationship to metoclopramide. The drug was stopped and her symptoms subsided over approximately 8 hours. Palatopharyngeal myoclonus is typically a slow form of tremor at 1 to 4 Hz. It can involve the pharynx, larynx, diaphragm, and extend to involve even eye muscles. The rhythmic movement can occur both during phonation and at rest. Voice tremor and clicking or popping sounds can be associated with the movement. The disorder is usually secondary to an interruption in the central tegmental tract from brainstem infarct or from idiopathic degeneration. Treatment may include serotonin precursors, carbamazepine, and clonazepam, but in general the condition is resistant to treatment. Previously described adverse reactions to metoclopramide include several conditions associated with more typical neuroleptic agents: acute dystonias, parkinsonian symptoms, including perioral, jaw, and extremity rest tremors, akathisia, tardive dyskinesia in several clinical forms, and neuroleptic malignant syndrome.1,2 The risk of developing metoclopramide-induced movement disorders has been found to increase with age, female sex, and some coexistent illnesses.1,3 Diabetes mellitus appears to confer additional risk for extrapyramidal symptoms.4 There is a 2:1 risk ratio for tardive dyskinesia in diabetics compared to nondiabetics.5 Diabetics who have been treated with metoclopramide also have a significantly greater severity of tardive dyskinesia than nondiabetics who have been treated with metoclopramide.5 We alert colleagues to our observation because we have not found other reports of metoclopramide-induced palatopharyngeal myoclonus/tremor, and because the patient responded fully and promptly to metoclopramide cessation.