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[Primary orthostatic tremor].

A Pradalier1, E Apartis, D Vincent

  • 1Service de médecine interne 4, hôpital Louis-Mourier, 178, rue des Renouillers, 92700 Colombes, France. secretariat.medecine4@lmr.ap-hop-paris.fr

La Revue De Medecine Interne
|March 6, 2002
PubMed
Summary
This summary is machine-generated.

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Primary orthostatic tremor, a condition causing unsteadiness when standing, is treatable. Clonazepam is the first-line therapy, with primidone or gabapentin as alternatives for resistant cases.

Area of Science:

  • Neurology
  • Neurophysiology

Background:

  • Primary orthostatic tremor (OT) was first described in 1984.
  • OT accounts for approximately 4% of tremors evaluated in neurophysiology.
  • It is less common than essential (28%) and parkinsonian (22%) tremors.

Observation:

  • Orthostatic tremor manifests exclusively while standing.
  • Symptoms resolve with walking, sitting, or lying down.
  • Clinical examination may reveal unsteadiness that disappears upon ambulation.

Findings:

  • Diagnosis requires surface electromyography (EMG) in a standing position.
  • EMG reveals a regular, rapid tremor with a frequency of 14–18 Hz.
  • The pathophysiology of orthostatic tremor remains unknown.

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Implications:

  • Clonazepam is the established first-line treatment for orthostatic tremor.
  • Primidone and gabapentin are effective alternatives for managing resistant or intolerant cases.
  • Gabapentin offers a viable treatment option for patients experiencing side effects from first-line therapies.