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Orthostatic Tremor

Orthostatic Tremor

Information, News, Research, and Discussion

Research Articles and Information:

The following information contains links to the source documents, as we become aware of new information we will try to add to this list.
medical disclaimer - website disclaimer

Research Articles and Information:

The following information contains links to the source documents, as we become aware of new information we will try to add to this list.
medical disclaimer - website disclaimer
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THE LONG-TERM OUTCOME OF ORTHOSTATIC TREMOR - Orthostatic tremor is a progressive disorder with increased disability although tremor frequency is unchanged over time. In most cases, orthostatic tremor represents an isolated syndrome. Drug treatments are unsatisfactory but surgery may hold promise.

Shaking on Standing: A Critical Review Here, we provide a critical review of the clinical spectrum of shaking on standing, along with demonstrative electrophysiological recordings of some of these conditions.

Clinical and Neurophysiologic Spectrum of Orthostatic Tremor: Case Series of 26 Subjects - This report is one of the largest OT series describing clinical and neurophysiologic findings in 26 subjects with OT. Tremor analysis: standing on one foot, transition from sitting to standing, to sitting: This is page 4 of the Case Series Study. - LINK

Involvement of cranial muscles and high intermuscular coherence in orthostatic tremor. Electromyographic recordings were conducted from limb, trunk, and cranial muscles in 6 patients with orthostatic tremor. Spectral analysis revealed a high-frequency tremor not only in the muscles of the limbs and trunk, but also in cranial muscles.

Primary orthostatic tremor is an exaggeration of a physiological response to instability. In this study, EMG was recorded from tibialis anterior in healthy subjects who were made unsteady through vestibular galvanic stimulation or leaning backwards. Under these conditions, a peak at approximately 16 Hz was seen in the coherence between the left and right tibialis anterior. This bilateral coherence was absent when the subjects activated the same muscles when not unsteady. These data indicate the existence of a physiological system involved in organising postural responses under circumstances of imbalance and characterised by a highly synchronised output at approximately 16 Hz. In addition, the results suggest that the core abnormality in POT may be an exaggerated sense of unsteadiness when standing still, which then elicits activity from a 16-Hz oscillator normally engaged in postural responses. Mov Disord 2003 Feb

A Video Library of Gait, Movement and Tremor Disorders OT, Essential Tremor, Parkinsonian, Cerebellar, Hyperthyroid Tremor, Dystonic, Neuropathic and others.

A retrospective study of the clinical and electrophysiological characteristics of 32 patients with Orthostatic Myoclonus . Conclusions: OM has some similarities to OT, including causing "shaky legs" subjectively in standing older patients. Novel data from this work include that, as in OT, OM essentially abates when patients remove their weight from their legs. This shared isometric phenomenon may reflect that OT and OM are on a pathophysiological continuum. Further, many patients who complain of their legs "shaking" while standing may have neither OT nor OM. Surface electromyography may be a useful adjunct in extrapolating patients complaining of "shaky legs."

A Slow Orthostatic Tremor of Primary Origin: OT of primary origin is not necessarily a high-frequency tremor; it can also occur in a lower frequency of 10–11Hz.


Pseudo-Orthostatic Tremor : dominant frequency 6.2 to 6.9 sporadic subharmonics at 8 to 18 Hz... all patients had dopamine transporter abnormalities.

Tinnitus (ringing in ears) with OT .... reported bilateral tinnitus, which increased with instability, but no episodes of vertigo or hearing loss - read more...

Familial orthostatic tremor: An additional report in siblings - a family in which 2 siblings have clinically and physiologically documented OT.


Evidence for a non-orthostatic origin of orthostatic tremor The aim of this study was to determine if orthostatic tremor is invariably associated with the orthostatic and weight bearing conditions in the arms and legs, and to investigate the features of orthostatic tremor under different levels of peripheral loading. Shows tremors in a supine position (lying face up) with isometric contraction of arms and legs.

Acoustic Startle Response in Patients with Orthostatic Tremor - Our results increase the possibility that brainstem and diencephalon serve as anatomic substrates in orthostatic tremor pathogenesis.

Body Tremors Have A Genetic Cause The latest issue of The American Journal of Human Genetics now reveals that researchers from Montreal University and its affiliated CHU Sainte-Justine and CHUM hospitals have managed to link some cases of Essential Tremor (ET) to a specific genetic problem.


Orthostatic Tremor a review of 40 Cases - review of medical records of 40 patients seen at the Baylor College of Medicin Parkinson’s Disease Center and Movement Disorders Clinic between 1987 and 2010. A review of 40 cases in which 15 percent of the sampling had “OT plus” additional neurological features including Parkinson’s, restless legs syndrome, 2 with parkinsonism, 1 with ataxia and 1 with hemifacial spasm. Contains a chart of OT, “OT plus” and All OT

Unilateral Standing Leg Tremor as the Initial Manifestation of Parkinson Disease : There are several forms of standing leg tremor (SLT) in that it is present only while standing, and disappears while a subject is sitting down or walking

Slow Orthostatic Tremor can persist when walking backwards - Classically orthostatic tremor and the associated symptom of intense unsteadiness disappear with ambulation1. Here we describe a patient with cerebellar atrophy who presented with slow orthostatic tremor, which disappeared when walking forwards, but persisted when walking backwards.


Shaky legs? Think POT! .... three cases seen in a general neurology clinic over a 15-month period to highlight the typical clinical features which should alert clinicians to the possibility of this diagnosis.

Characterizing orthostatic tremor: a study of 56 patients : The age at OT onset distribution had a single peak and was a decade later than essential tremor (ET), which is bimodal. Symptomatic leg tremor was ubiquitous, but OT affected the arms in 50%, head (20%), trunk (16%) and voice and tongue (both 7%) of cases.

Is the spinal cord the generator of 16-Hz orthostatic tremor? This raises the possibility that the spinal cord could be the source of orthostatic tremor.

Primary orthostatic tremor in giant breed dogs The tremors typically begin in the lower aspects of the legs, but can also involve the muscles of the head and face. The tremors are usually first apparent at a young age (1-2 years).
A 55 minute video - "Orthostatic Tremor" Visiting Professor: Diego Torres-Russotto, MD Washington University in St. Louis, School of Medicine. Scroll down the page and look for the first listing under "November Grand Rounds". November 29, 2007 "Orthostatic Tremor" Visiting Professor: Diego Torres-Russotto, MD Washington University in St. Louis, School of Medicine

Presentation notes from the October 8th talk at the National Tremor Foundation by Dr. Peter Bain, Charing Cross Hospital, London
We describe changes in the extent of sway in a man with orthostatic tremor (OT) who reported increased stability after alcohol.

We have reviewed these aspects in 41 OT patients fulfilling current diagnostic criteria, seen at our institution between 1986 and 2001.

The aim of this study was to determine if orthostatic tremor is invariably associated with the orthostatic and weight bearing conditions in the arms and legs, and to investigate the features of orthostatic tremor under different levels of peripheral loading.

[123I]-FP-CIT-SPECT demonstrates dopaminergic deficit in orthostatic tremor There is increasing evidence of a potential role of the dopaminergic system in orthostatic tremor (OT)

Quality of life in patients with orthostatic tremor :We conclude that OT strongly impacts on QoL (quality of life). The results highlight the importance of recognizing and treating depression in patients with OT.

Technology Review has an interesting article about a bioengineer at Boston University that is using "noise" to enhance weak signals that are related to balance.
This link is only for a preview to the article and a slide show.

Developing Unique Brain Maps To Assist Surgery And Research "Microscopic images inside the living brain will transform diagnosis and treatment of diseases such as multiple sclerosis, Parkinson's disease, Alzheimer's disease and Huntington's disease," A/Prof Egan said.
Its prevalence accounts for around 4% for tremors explored in neurophysiology-Rev Med Interne 2002 Feb;23(2):193-7

Primary orthostatic tremor: slow harmonic component as responsible of instability The full report in spanish can be found here

The pathophysiology of tremor.-Orthostatic tremor is likely to originate in hitherto unidentified brainstem nuclei.

Orthostatic tremor arises from an oscillator in the posterior fossa. tested the hypotheses that orthostatic tremor is generated by a central oscillator and that the tremor is expressed through spinal Ib interneurons.

The main aim of this study was to see if the characteristic postural tremor in OT can be identified with force platforms. 2001 Feb;13 London UK
"Primary" orthostatic tremor. 10 clinical electrophysiologic observations observations of 3 men and 7 women, 37 to 74 years old with OT
A dissociation between subjective and objective unsteadiness in primary orthostatic tremor. "standing under four conditions (eyes open or closed, feet together or apart) in six patients with OT. "
http://www.postgradmed.com/issues/2000/07_00/cooper.htm A more indepth look at the classification of tremors,
http://www.aafp.org/afp/990315ap/1565.html Another good reference on classification of tremors

Long-term course of orthostatic tremor in serial posturographic measurement - Primary Orthostatic Tremor is a progressive disorder that impacts seriously on quality of life.

Shaking on Standing: A Critical Review Here, we provide a critical review of the clinical spectrum of shaking on standing, along with demonstrative electrophysiological recordings of some of these conditions.

A New teaching video has been posted on Neurology.org
“Orthostatic Tremor: The Helicopter Sign”, this video contains the audio of the sound of the tremor, the chart of the sEMG and shows the legs of the patient under test. click to read more....

”OT is a neurologic condition manifested by tremors, mainly in the legs, but also in the cranial structures, arms, and trunk”
Clinical and Neurophysiologic Spectrum of Orthostatic Tremor: Case Series of 26 Subjects , and ringing in ears (tinnitus)

Importance of electromyography studies in the diagnosis of orthostatic tremor : study includes reference EMG illustration

Surface electromyographic (EMG) recordings: This study shows that the diagnosis can be established rapidly with surface electromyographic recordings.

Diagnosis is usually obtained based on clinical evaluation combined with surface electromyogram (EMG). Surface EMG contains a high-frequency component -- 16 to 18 Hz. Misdiagnosis is common and many patients are initially thought to have a non-organic (psychogenic) balance disorder. Frequency domain analysis of surface EMG or sway traces can diagnose this condition (Yarrow et al, 2001). As a similar tremor can be induced in normal persons via vestibular stimulation (Sharott et al, 2003), conditions that cause imbalance should be considered in addition.


Posturography can be used to screen for primary orthostatic tremor


Link: CONCLUSION: Analysis of power spectra from posturographic recordings is a simple, quick method to screen for primary orthostatic tremor. The condition might be more common than previously assumed. It is important to identify patients with primary orthostatic tremor because they might be misdiagnosed and left without treatment.


A dissociation between subjective and objective unsteadiness in primary orthostatic tremor ... to study the relationship between the development of subjective unsteadiness, objective unsteadiness and tremor, we recorded standing under four conditions (eyes open or closed, feet together or apart) in six patients with OT.


The timing of primary orthostatic tremor bursts has a task-specific plasticity…..This analysis reveals a linkage between these oscillations with a complex and task-specific pattern of phase delays and suggests that these phase delays may reflect the activity of normally occurring neural networks or oscillators involved in postural control.


Orthostatic tremor can also be palpated as a kind of ‘rhythmic shivering’ of the legs, or can be heard through a stethoscope (thumping sound like a helicopter) in cases where it is not obviously visible.25 - Brown, P. New clinical sign for orthostatic tremor. Lancet 346, 306–307 (1995)


Orthostatic Tremor - A Review of 40 cases: Baylor College of Medicine, Houston, Texas


Using an Iphone to diagnose? An interesting article that may point towards future innovation: The challenge is finding a universally accessible, easily used device that can give a quick, accurate representation of tremor characteristics. Here, we present the use of the iPhone seismograph application (iSeismo by ObjectGraph LLC) in tremor detection and measurement.
(
and just incase you have an iphone and are curious, here’s the link to the iphone app... it’s free )

Another new iPhone app has been developed called
Lift Pulse. Using a Fourier Transform, this app can identify your tremor and calculate it's magnitude.
Click Here to read the discussion on iPhone apps in the OT Forum.


A Slow Orthostatic Tremor of Primary Origin: OT of primary origin is not necessarily a high-frequency tremor; it can also occur in a lower frequency of 10–11Hz.
Gabapentin can improve postural stability and quality of life in primary orthostatic tremor. : Gabapentin may improve tremor, stability, and QOL in patients with OT, and symptomatic response correlated with a reduction in tremor amplitude and postural sway.

Gabapentin in orthostatic tremor: results of a double-blind crossover with placebo in four patients.

Effective treatment of orthostatic tremor with gabapentin. Mov Disord, 1998 Sep, 13:5, 829-31

Report: Levetiracetam (Keppra) is ineffective in the treatment of orthostatic tremor


Shaky-Leg Syndrome and Vitamin B12 Deficiency A 68-year-old man presented with a three-year history of trembling of the legs….Results of laboratory tests were remarkable only for a serum vitamin B12 level of 132 ng per liter (normal range, 222 to 753)….The association of shaky-leg syndrome with vitamin B12 deficiency in our patient might have been a coincidence. However, the fact that the tremor did not recur after discontinuation of clonazepam supports this association.

Gabapentin in the treatment of tremor: 63 patients aged 59.4 years (SD, 16 years): 34 essential tremor, 16 Parkinson s disease tremor, 10 multiple sclerosis tremor, 4 writing tremor and 3 orthostatic tremor.


There are a variety of treatments that visitors have reported in attempts to control this disorder, and the most current can be found and discussed on the user
forum.
Orthostatic myoclonus - this link from Mayo Clinic describes a unique clinical and physiologic phenomenon that accompanies a slowly progressive and eventually disabling gait disorder in the elderly. This phenomenon often arises in the company of more widespread CNS disease.

Orthostatic myoclonus : this link describes the same phenomenon but the author believes Orthostatic myclonus to be the same as OT

Tardive Orthostatic Tremor
Four patients who developed orthostatic tremor after exposure to dopamine blocking drugs

Orthostatic tremor induced by pharmaceuticals: ...four patients who developed orthostatic tremor after exposure to dopamine blocking drugs: metoclopramide(Reglan), sulpiride, thyethylperazine (Torecan)

Parkinson’s disease

Pseudo-Orthostatic Tremor : dominant frequency 6.2 to 6.9 sporadic subharmonics at 8 to 18 Hz... all patients had dopamine transporter abnormalities.

Fast orthostatic tremor in Parkinson's disease mimicking primary orthostatic tremor.

Multiple Sclerosis

Cerebrospinal Fluid Leaks




Additional research links can be found on the forum ... click to view....

If you have a published article and would like the OT Resource to link to it, please let us know.

** The information above contains links to the source documents, as we become aware of new information we will try to add to this list, we are only passing along this information and not making any conclusions about techniques used in diagnosis, misdiagnoses etc.
ABOUT THIS SITE:
The purpose of this site is to share information about Primary Orthostatic Tremor (OT). Since my diagnosis, my quest to learn more about this disorder has been frustrating and difficult to track. Hopefully, for all persons interested in this disorder, this website will become a coordinating link for collecting information, contacting other people with OT, and spreading awareness of this problem. Here you will find an active forum, my story / blog, and many other people that have shared their stories, advice and tips on coping with Orthostatic Tremor. If you have any information, suggestions, stories or services that you would like to share please email me.
This website is intended to be an informal guide. Any information relating to a therapy, treatment or diagnosis must be received with caution. Only a physician is authorized to confirm its validity. It must not, under any circumstances, delay or replace the advice of the treating physician. And is not a substitute for medical advice.

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