Q: I would like information on orthostatic tremor. The symptoms look like Parkinson’s disease to me but my doctor says that’s not what I have. Can you provide any information for me?
A: An orthostatic tremor affects the muscles of the legs and trunk and can radiate upward to other portions of the body. Orthostatic refers to being in a standing position. Thus, orthostatic tremor occurs when an individual is in a standing position and disappears when lying down or sitting. This rather uncommon disorder resembles shakiness and unsteadiness of the legs when standing still and oddly enough, the tremor will decrease if the individual begins walking. However, that fact does not over-ride the feeling of risk of injury from falling. The tremor experienced is of high frequency, meaning the rhythm is extremely rapid with between 8 to 12 cycles of tremors each second. Those associated with Parkinson’s occur only at a rate of between four to eight per second. Further, Parkinson’s has a tremor that is visible to anyone nearby, while the orthostatic tremor isn’t pronounced to the untrained eye.
Because the tremor is so rapid, it is difficult to diagnose since a physician directs his attention to other possible causes for the unsteadiness experienced; however, diagnosis might be accomplished by a physician placing a hand on the person’s thigh to “palpate” the tremor as it occurs. Confirmation can be accomplished in a sophisticated movement disorder laboratory which will document electrical activity when the patient is in a standing position and the lack of electrical activity when the patient sits.
While the cause of this condition remains unknown, there are treatment options available that might include medication such as clonazepam or a similar drug that has a success rate for reduction of symptoms in almost 35% of all patients. For others, it will eliminate the tremor altogether which is a positive point since there are no other groups of medication that perform as well. Clonazepam is in a group of drugs known as benzodiazepines that affects the chemicals in the brain that may become unbalanced and cause anxiety, as well. On the bright side, this is not a progressive disorder, as is Parkinson’s. The condition will not resolve on its own without drug intervention but symptoms will not worsen as an individual ages. Orthostatic tremor can cause extreme apprehension to the affected individual whose life can be greatly compromised.
Readers who would like related information can order Dr. Gott’s Health Report “Parkinson’s Disease” by sending a self-addressed, stamped number 10 envelope and $2 in the form of a US check or money order payable to Dr. Gott’s Health Report, PO Box 433, Lakeville, CT 06039. Be sure to mention the title when writing or print out an order form from our website www.AskDrGottMD.com.
