Orthostatic Tremor: An Update on a Rare Entity
Posted: Mon May 29, 2017 11:52 am
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
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.