Dominic Stone
Orthostatic tremor (OT) is a rare movement disorder that causes rapid muscle contractions in the legs when standing, leading to unsteadiness. The tremors are involuntary, rhythmic contractions that occur in both legs and can cause a feeling of vibration or loss of balance. While the tremors are typically not visible to the naked eye, they can be felt by touching the thighs or calves, or heard through a stethoscope. Orthostatic tremor is often misdiagnosed or underdiagnosed due to its rarity, and there is currently no cure. However, certain medications and treatments may help improve symptoms.
| Characteristics | Values |
|---|---|
| Main symptom | Feeling of unsteadiness while standing but not while sitting or walking |
| Tremor frequency | 13–18 Hz |
| Tremor type | Rhythmic bursts of muscular activity |
| Tremor location | Legs, head, voice, tongue, trunk, hands |
| Tremor detection | Palpation, stethoscope, electromyography |
| Tremor treatment | Clonazepam, gabapentin, deep brain stimulation, spinal cord stimulation, physical aids, muscle strength training |
| Tremor diagnosis | Surface electromyogram, blood tests, imaging tests |
| Tremor progression | Slowly progressive, severity varies between patients |
| Related disorders | Parkinson's disease, essential tremor, orthostatic myoclonus |
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What You'll Learn
- Orthostatic tremors are involuntary, rapid muscle contractions in the legs when standing
- Tremors disappear when walking, sitting, or lying down
- The main symptom is unsteadiness, but there is no pain
- It is a rare condition, often misdiagnosed as functional (psychogenic) tremor
- There is no cure, but medications like benzodiazepines may help improve symptoms
Orthostatic tremors are involuntary, rapid muscle contractions in the legs when standing
Orthostatic tremor (OT) is a rare movement disorder that causes rapid, involuntary muscle contractions (tremors) in the legs when standing. The condition was first described in 1970, and the term "orthostatic tremor" was coined in 1984. OT is characterised by unsteadiness and a loss of balance when standing, which is relieved when sitting or walking. The tremors are typically not painful, but individuals may develop leg muscle pain over time. The severity of the condition varies, with some people experiencing tremors immediately upon standing, while others may stand for several minutes before the tremors begin.
The main symptom of OT is the occurrence of a rapid tremor affecting both legs while standing, known as a "lower body tremor". This can cause a feeling of vibration or a "thudding sound", and may be visible, palpable, or detected through muscle auscultation (listening to the muscles with a stethoscope). The tremors are typically at a high frequency of 13-18 Hz, although some cases of slow OT with frequencies below 13 Hz have also been reported.
The exact cause of OT is unknown, and there is currently no cure. However, certain medications can help improve symptoms, such as clonazepam, gabapentin, pregabalin, and propranolol. OT can be difficult to diagnose, and it is often misdiagnosed as other conditions, such as functional (psychogenic) tremor or essential tremor. The condition can significantly impact an individual's daily life and quality of life, and many people with OT use wheelchairs or other mobility aids.
Orthostatic myoclonus is a similar condition that is characterised by sudden, involuntary jerking of a muscle or group of muscles caused by muscle contraction or relaxation. This condition can also cause unsteadiness when standing, and it may be associated with an underlying neoplasm in rare cases. More research is needed to determine if orthostatic myoclonus and OT are the same disorder or distinct disorders.
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Tremors disappear when walking, sitting, or lying down
Orthostatic tremor (OT), also known as "shaky legs syndrome", is a rare condition that causes rapid muscle contractions in the legs when standing, leading to unsteadiness. The tremors disappear or improve when walking, sitting, or lying down. OT can be idiopathic or secondary. While the exact cause of OT is unknown, some experts think it is a variation of essential tremor, while others believe it is a distinct condition. OT is characterised by unsteadiness when standing that is relieved by sitting or walking.
The main symptom of OT is the occurrence of a rapid tremor affecting both legs while standing. A tremor is involuntary, rhythmic contractions of various muscles. OT causes feelings of "vibration", unsteadiness, or imbalance in the legs. The tremor is position-specific (standing) and disappears partially or completely when an affected individual walks, sits, or lies down. In many cases, the tremor becomes progressively more severe, and feelings of unsteadiness become more intense.
The tremors are typically not painful while they are happening, but some people may develop leg muscle pain over time. Some people with OT also experience tremors in their hands, trunk, head, voice, or tongue, although this is less common. OT can create difficulty in performing daily activities that require standing freely without support, such as standing in line at a store or preparing a meal.
While there is no cure for OT, certain medications can improve symptoms. The go-to medication is typically clonazepam, which eliminates or reduces tremors in about one-third of people with OT. Other options include gabapentin and propranolol, although not everyone responds well to these medications. Mobility aids and occupational therapy can also help make everyday tasks more manageable.
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The main symptom is unsteadiness, but there is no pain
Orthostatic tremor is a rare condition that causes rapid muscle contractions in the legs when standing, leading to unsteadiness. The main symptom is a feeling of unsteadiness, but there is no pain. The tremors are involuntary, rhythmic contractions of various muscles. They are very fast and may not be visible to the naked eye, but they can be felt by touching the thighs or calves. The tremors are position-specific and usually disappear when the affected individual walks, sits, or lies down.
The high-frequency rhythmic bursts of muscular activity can be detected on surface electromyography (EMG) as part of the diagnosis criteria. EMG evaluates the health and function of skeletal muscles and the nerves that control them. The diagnostic procedure consists of confirming a >12 Hz tremor in weight-bearing muscles during stance and its absence after sitting or not placing weight on the feet.
The condition is likely under-diagnosed, and misdiagnosis is common. The impact on patients' everyday lives and quality of life is often underestimated. Many individuals may initially be suspected of having a psychogenic disorder or functional movement disorder. There is no cure for orthostatic tremor, but certain medications may help improve symptoms. The go-to medication is typically clonazepam (a benzodiazepine), but not everyone responds well to this treatment. Other options include gabapentin, propranolol, pregabalin, and phenobarbital.
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It is a rare condition, often misdiagnosed as functional (psychogenic) tremor
Orthostatic tremor (OT), also known as "shaky legs syndrome", is a rare condition that causes rapid muscle contractions in the legs when standing, leading to unsteadiness. It is relieved when walking or sitting. The main symptom of primary orthostatic tremor is the occurrence of a rapid tremor affecting both legs while standing. The tremor is involuntary, rhythmic, and can cause feelings of "vibration", unsteadiness, or imbalance in the legs.
The condition is often misdiagnosed as functional (psychogenic) tremor, a type of functional movement disorder. This is due to its rarity and the limited understanding of the condition. The current understanding of OT is mostly based on small case series or case reports. The diagnosis of OT is based on the history of unsteadiness during standing, which is then confirmed by electromyographic findings of a 13–18 Hz tremor that is absent when sitting or lying down.
The tremors may start suddenly when changing to a standing position, or they may take several minutes of standing before they begin. For many, the tremors worsen over time. The severity of orthostatic tremor can vary, and in some rare cases, individuals with orthostatic tremor may experience stiffness, weakness, and pain in the legs. In some cases, the tremor may also affect the arms, head, voice, and tongue.
There is no cure for orthostatic tremor, but certain medications may help improve symptoms. The go-to medication is typically clonazepam (a benzodiazepine). Other options include gabapentin, propranolol, and perampanel.
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There is no cure, but medications like benzodiazepines may help improve symptoms
Orthostatic tremor (OT), also known as "shaky legs syndrome", is a rare movement disorder that causes rapid muscle contractions or tremors in the legs when standing. The tremors disappear when walking, sitting, or leaning, but they can cause a feeling of unsteadiness or loss of balance. OT can be idiopathic or secondary, and while it does not develop into other conditions, the tremors often get more severe over time. The cause of OT is unknown, and there is currently no cure. However, certain medications can help improve symptoms.
While there is no cure for orthostatic tremor, certain medications can help improve symptoms. The go-to medication is typically clonazepam, a benzodiazepine. Benzodiazepines are known to increase cortical beta activity, which is believed to act as a blocking mechanism for activity in pathological neural networks, leading to a reduction in tremors. However, benzodiazepines can cause adverse central nervous system events and have abuse potential, so they need to be administered judiciously. Other medications that can be used include gabapentin, propranolol, and primidone.
In medically refractory cases, injections of Botulinum Toxin-A in the tremorogenic muscles may be useful. This treatment has been shown to be effective for limb, head, and voice tremors, but it should only be performed by a trained and experienced neurologist. Surgical treatment is reserved for patients with severe tremors that are not adequately controlled by medical therapy.
It is important to note that orthostatic tremor is often misdiagnosed due to its rarity. Therefore, it is crucial to consult a healthcare professional for an accurate diagnosis and personalized treatment plan. While there is no cure, the available treatments can help improve symptoms and manage the condition.
In summary, orthostatic tremor is a rare movement disorder with no known cure. However, medications like benzodiazepines, specifically clonazepam, can help improve symptoms by reducing tremors. Other treatments, such as injections or surgery, may also be considered in medically refractory cases. It is important to consult a healthcare professional for an accurate diagnosis and personalized treatment approach.
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Frequently asked questions
Orthostatic tremor (OT) is a rare movement disorder that causes rapid muscle contractions in the legs when standing, leading to unsteadiness. It is characterised by a high-frequency (>12 Hz) tremor that occurs in weight-bearing muscles and disappears when not standing.
The main symptom of orthostatic muscle tremors is a feeling of unsteadiness when standing, which can lead to a fear of falling. Other symptoms include discomfort, dizziness, shaking, trembling sensations, and trembling of limbs and the trunk. The tremors are typically not painful, but leg muscle pain can develop over time.
Orthostatic muscle tremor is diagnosed by confirming a high-frequency (>12 Hz) tremor in weight-bearing muscles during standing and its absence when sitting or not placing weight on the feet. Surface electromyography can be used to measure electrical impulses in the muscles and reproduce the characteristic tremor.
