Orthostatic tremor: Clinical, electrophysiologic, and treatment findings in 184 patients

Anhar Hassan, J. Eric Ahlskog, Joseph Y. Matsumoto, Joshua M. Milber, James Howard Bower, Jayne R. Wilkinson

Research output: Contribution to journalArticle

34 Citations (Scopus)

Abstract

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 b-blockers and anticonvulsants. DBS should be further explored for treatment.

Original languageEnglish (US)
Pages (from-to)458-464
Number of pages7
JournalNeurology
Volume86
Issue number5
DOIs
StatePublished - Feb 2 2016

Fingerprint

Tremor
Deep Brain Stimulation
Benzodiazepines
Anticonvulsants
Therapeutics
Leg
Essential Tremor
Delayed Diagnosis
Weight-Bearing
Parkinsonian Disorders
Nervous System Diseases
Age of Onset
Medical Records
Arm
Demography

ASJC Scopus subject areas

  • Medicine(all)
  • Clinical Neurology

Cite this

Orthostatic tremor : Clinical, electrophysiologic, and treatment findings in 184 patients. / Hassan, Anhar; Ahlskog, J. Eric; Matsumoto, Joseph Y.; Milber, Joshua M.; Bower, James Howard; Wilkinson, Jayne R.

In: Neurology, Vol. 86, No. 5, 02.02.2016, p. 458-464.

Research output: Contribution to journalArticle

Hassan, Anhar ; Ahlskog, J. Eric ; Matsumoto, Joseph Y. ; Milber, Joshua M. ; Bower, James Howard ; Wilkinson, Jayne R. / Orthostatic tremor : Clinical, electrophysiologic, and treatment findings in 184 patients. In: Neurology. 2016 ; Vol. 86, No. 5. pp. 458-464.
@article{c6366029efda4edda798909437a6fe23,
title = "Orthostatic tremor: Clinical, electrophysiologic, and treatment findings in 184 patients",
abstract = "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 b-blockers and anticonvulsants. DBS should be further explored for treatment.",
author = "Anhar Hassan and Ahlskog, {J. Eric} and Matsumoto, {Joseph Y.} and Milber, {Joshua M.} and Bower, {James Howard} and Wilkinson, {Jayne R.}",
year = "2016",
month = "2",
day = "2",
doi = "10.1212/WNL.0000000000002328",
language = "English (US)",
volume = "86",
pages = "458--464",
journal = "Neurology",
issn = "0028-3878",
publisher = "Lippincott Williams and Wilkins",
number = "5",

}

TY - JOUR

T1 - Orthostatic tremor

T2 - Clinical, electrophysiologic, and treatment findings in 184 patients

AU - Hassan, Anhar

AU - Ahlskog, J. Eric

AU - Matsumoto, Joseph Y.

AU - Milber, Joshua M.

AU - Bower, James Howard

AU - Wilkinson, Jayne R.

PY - 2016/2/2

Y1 - 2016/2/2

N2 - 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 b-blockers and anticonvulsants. DBS should be further explored for treatment.

AB - 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 b-blockers and anticonvulsants. DBS should be further explored for treatment.

UR - http://www.scopus.com/inward/record.url?scp=84957602471&partnerID=8YFLogxK

UR - http://www.scopus.com/inward/citedby.url?scp=84957602471&partnerID=8YFLogxK

U2 - 10.1212/WNL.0000000000002328

DO - 10.1212/WNL.0000000000002328

M3 - Article

C2 - 26747880

AN - SCOPUS:84957602471

VL - 86

SP - 458

EP - 464

JO - Neurology

JF - Neurology

SN - 0028-3878

IS - 5

ER -