Clinical,
electrophysiologic, and treatment findings in 184 patients
Objective: To evaluate the
clinical, electrophysiologic, and treatment outcome features of orthostatic
tremor (OT) in a large case series.
Methods: We performed medical
record review of 184 patients who met clinical and electrodiagnostic criteria
for OT from 1976 to 2013 at the Mayo Clinic. Demographic, clinical,
electrophysiologic, and treatment data were extracted.
Results: The majority of OT
cases were female (63.6%) and mean age at onset was 59.3 years (range 13–85
years). Diagnosis was delayed by a mean of 7.2 years (range 0–44 years). The
average tremor frequency was 15.7 Hz (range 12.5–20 Hz), and transmitted to the
arms on weight-bearing (95.5%). Patients reported a spectrum of progressive
orthostatic leg symptoms, relieved by sitting or leaning. Falls were reported
in 24.1%. Coexistent neurologic disorders included essential tremor (22.8%),
other tremor (4.9%), and parkinsonism (8.7%). Family history of OT was noted in
4.9%. Of 46 medications trialed, 24 failed to provide any benefit.
Benzodiazepines provided at least mild benefit in 55.9%, and moderate to marked
benefit in 31.5%; β-blockers (31.0%) and anticonvulsants (25.0%) provided mild
benefit, and the remainder were largely ineffective. Medication benefit waned
over time. Deep brain stimulation (DBS) was effective in 2 cases.
Conclusion: OT predominantly
affects female seniors, and the diagnosis should be considered with any
orthostatic-induced leg symptoms, and confirmed by surface EMG. Benzodiazepines
are the most efficacious treatment, followed by β-blockers and anticonvulsants.
DBS should be further explored for treatment.
FOOTNOTES
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for full disclosures. Funding information and disclosures deemed relevant by
the authors, if any, are provided at the end of the article.
Anhar Hassan, MBBCh, FRACP, J. Eric Ahlskog, PhD, MD, Joseph Y. Matsumoto, MD, Joshua M. Milber, BA, MPH, James H. Bower, MD and Jayne R. Wilkinson, MD, MSCE
http://www.neurology.org/content/86/5/458.short?sid=c2cee3d8-b35b-4b1c-ae44-87b49c54ba7c
Objective: To evaluate the clinical, electrophysiologic, and treatment outcome features of orthostatic tremor (OT) in a large case series.
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