Orthostatic Tremor: An Update on a Rare Entity

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Orthostatic Tremor: An Update on a Rare Entity

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Orthostatic Tremor: An Update on a Rare Entity. A review of 219 research papers on Orthostatic Tremor.

Authors - Julián Benito-León and Ángela Domingo-Santos

Link to full article
OT is a rare and singular movement disorder that is characterized by tremor of the legs and trunk, and is present on standing and improving on walking or sitting. The origin and mechanism of this condition are not well understood; notwithstanding, most studies suggest that it arises from an oscillator in the posterior fossa, possibly in the brainstem and/or the cerebellum. Although OT is generally considered to be a distinct and primarily “idiopathic” disorder, with normal brain MRI and laboratory work-up, symptomatic OT cases have been described as well.

We are now seeing the clinical expansion of the concept of OT in recent years to include other neurological features (cerebellar dysfunction signs) and non-motor features (cognitive problems, psychiatric problems), the heterogeneity of pharmacological response profiles and clinical progression, and the association of OT with Parkinson’s disease and other types of parkinsonism. We propose that OT might be a family of diseases, unified by the presence of leg tremor, but further characterized by etiological and clinical heterogeneity. Effective pharmacological treatments for the disorder remain limited, although new insights into disease mechanisms might result in more-effective therapies. Along with this, advanced neuroimaging techniques are now demonstrating distinct anatomical and functional changes, some of which are consistent with neuronal loss, in OT patients. However, more work is needed to understand the pathogenesis of this condition.
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Re: Orthostatic Tremor: An Update on a Rare Entity

Post by Mark »

I would be interested to know if others admit that OT symptoms include cognitive or phsychiatric problems. I will admit to memory issues and perhaps I am noticing that my mental reasoning is less effective than it used to be. Perhaps these are symptoms of old age. Do others find that, rather than progressing, the tremors decrease for a few days?
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Re: Orthostatic Tremor: An Update on a Rare Entity

Post by magnbud »

I will admit to cloudy thinking at times. Some tasks requiring intellectual abilities seem more daunting than they used to and take me longer to complete. My Neurologist has told me some of it is a side effect of long term Neurontin use. Only a small percentage of patients have this side effect. I am slow to come up with names and occasionally say one word when I mean another.
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Re: Orthostatic Tremor: An Update on a Rare Entity

Post by Meem »

Thank you for your post suggesting mild cognitive impairment with OT and the possible role of long term use of Gabapentin in this. I have been taking Gabapentin for thirteen years since I was diagnosed with OT. For the last few years I have had occasional difficulty in recalling names and for the last six months this seems to have got worse along with other new neurological symptoms. I have discussed this with my GP, requested and been tested for memory loss (normal for my age) and had a brain MRI (normal) and yet I am not imagining my symptoms or cognitive impairment! I have often wondered if there is a link with OT and it seems there might well be. I have no trouble leading a normal life but wonder if cognitive decline is as slow as physical decline, with aging being another factor? I have had symptoms of OT for twenty years or more. Since so little is known about our disease all that we can do is modify whatever we can and I shall certainly consider giving up Gabapentin. Wishing you all the best. 😕
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