• Parkinsonism Relat. Disord. · Aug 2015

    Long-term course of orthostatic tremor in serial posturographic measurement.

    • K Feil, N Böttcher, F Guri, S Krafczyk, F Schöberl, A Zwergal, and M Strupp.
    • Department of Neurology, University Hospital Munich, Campus Grosshadern, Munich, Germany; German Center for Vertigo and Balance Disorders, University Hospital Munich, Campus Grosshadern, Munich, Germany. Electronic address: katharina.feil@med.uni-muenchen.de.
    • Parkinsonism Relat. Disord. 2015 Aug 1; 21 (8): 905-10.

    ObjectivePrimary orthostatic tremor (OT) is a rare neurological disease of unknown pathophysiology characterized by a high-frequency tremor mainly of the legs when standing. The aim of this study was to examine its long-term course by subjective estimation and objective recording by serial posturography and to obtain further standardized epidemiological and clinical data on patients with OT.MethodsA clinical cohort of 37 patients with the diagnosis of primary OT was screened for this longitudinal follow-up study. Eighteen patients consented to participate. During study visit all patients underwent a standardized neurological examination and completed subjective scales and scores. Posturographic recordings at follow-up were compared to prior clinical posturographic measurements in 15 cases.ResultsIn our cohort the mean duration of symptoms was 14.1 ± 6.8 years. Subjectively, 78% of patients reported progression of the disease. Posturographic data (5.4 ± 4.0 years) revealed a significant increase of the total sway path (standing on firm ground with eyes open) from 2.4 ± 1.3 to 3.4 ± 1.4 m/min (p = 0.022) and of the total root mean square values from 9.8 ± 4.3 to 12.4 ± 4.8 mm (p = 0.028). None of these observations are explained by aging of the patients. Mean frequency of the tremor did not change over time (14.7 ± 1.9 Hz vs. 14.9 ± 2.0 Hz at follow-up). Clinically, most patients had signs of cerebellar dysfunction and a substantial portion also showed proprioceptive deficits in the long-term course.ConclusionsThis long-term follow-up study indicates, that primary OT is a progressive disorder. Furthermore, the clinical observation of cerebellar dysfunction in most OT patients in the long-term course might indicate an important role of the cerebellum in its pathophysiology.Copyright © 2015 Elsevier Ltd. All rights reserved.

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