November 19, 2025

@michaelokun

Does Whipple's disease always manifest the oculomasticatory or oculofacioskeletal myorhythmia? Spoiler alert: NOPE and in fact only ~50% of cases have any noticeable involvement of the central nervous system. Maslias and colleagues dropped a new paper in Tremor and Other Hyperkinetic Movement Disorders and their comprehensive work sets the record straight. Key Points: - Myorhythmia and ataxia were the most frequently documented movements in Whipple's, each affecting ~40% of the 130 well-described patients. - W/in those w/ myorhythmia, 25% of the well-documented cases had the "pathognomonic oculomasticatory or oculofacioskeletal myorhythmia (OMM/OFSM)." - Digging into that group, the authors uncovered that when oculomotor features were well detailed, "pendular nystagmus of vergence type was noted in 83%." - Vertical nystagmus was described in 17%. - Palatal movements occurred in only 2 people (6%). - Persistence of the OMM/OFSM during sleep was noted in 9 cases or 28%. My take: Whipple’s is rare. It is a multi-systemic infection. The organism causing it is called Tropheryma whipplei and only a minority of those w/ Whipple's get the oculomasticatory or oculofacioskeletal myorhythmia. Don't miss this movement disorder as it is pretty unique. The syndrome is treatable w/ a simple antibiotic. This infection is tricky to identify and treat, so if you see this clue, I expect all of you will make the diagnosis and cure the person. https://tremorjournal.org/articles/10.5334/tohm.1075 #whipple #parkinson #movement #eyes #michaelokun #fixelinstitute