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Journal of Neurology, Neurosurgery, and Psychiatry logoLink to Journal of Neurology, Neurosurgery, and Psychiatry
. 1999 Mar;66(3):284–288. doi: 10.1136/jnnp.66.3.284

Evidence for a non-orthostatic origin of orthostatic tremor

B Boroojerdi 1, A Ferbert 1, H Foltys 1, C Kosinski 1, J Noth 1, M Schwarz 1
PMCID: PMC1736264  PMID: 10084525

Abstract

OBJECTIVES—Orthostatic tremor was first described by Heilman in 1984. It usually occurs in the legs during stance and decreases markedly during sitting or walking. The aim of this study was to determine if orthostatic tremor is invariably associated with the orthostatic and weight bearing conditions in the arms and legs, and to investigate the features of orthostatic tremor under different levels of peripheral loading.
METHODS—Multichannel surface EMG recordings were obtained under different conditions (body posture and peripheral loading) from the proximal arm and leg muscles of seven patients fulfilling the clinical and electrophysiological criteria of orthostatic tremor.
RESULTS—In weight bearing positions (stance; weight bearing on the hands on all fours), all patients showed 13 Hz-16 Hz tremor activity, predominantly in the active limb. No tremor activity could be found in a supine position with muscles at rest. Isometric contraction of the limbs in the supine position led to synchronous 13 Hz-16 Hz rhythmic activity in five patients. No tremor was seen when the subjects were suspended in a harness with relaxed legs. Isometric contraction of the legs in this position produced tremor in two patients. A stepwise reduction of the body weight by a harness reduced the tremor activity. Additional loading (10 kg-20 kg) during stance led to an increase in tremor amplitude, but tremor frequency remained unchanged.
CONCLUSIONS—Orthostatic tremor is invariably present during stance or other weight bearing positions. It is not, however, always associated with orthostasis. In at least some patients it can be classified as an orthostasis independent action tremor. The failure of peripheral loading to modify tremor frequency indicates that orthostatic tremor may have a central, rather than a peripheral, origin.



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Selected References

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  1. Bathien N., Rondot P., Toma S. Inhibition and synchronisation of tremor induced by a muscle twitch. J Neurol Neurosurg Psychiatry. 1980 Aug;43(8):713–718. doi: 10.1136/jnnp.43.8.713. [DOI] [PMC free article] [PubMed] [Google Scholar]
  2. Britton T. C., Thompson P. D., van der Kamp W., Rothwell J. C., Day B. L., Findley L. J., Marsden C. D. Primary orthostatic tremor: further observations in six cases. J Neurol. 1992 Apr;239(4):209–217. doi: 10.1007/BF00839142. [DOI] [PubMed] [Google Scholar]
  3. Deuschl G., Krack P., Lauk M., Timmer J. Clinical neurophysiology of tremor. J Clin Neurophysiol. 1996 Mar;13(2):110–121. doi: 10.1097/00004691-199603000-00002. [DOI] [PubMed] [Google Scholar]
  4. Deuschl G., Lücking C. H., Quintern J. Orthostatischer Tremor: Klinik, Pathophysiologie und Therapie. EEG EMG Z Elektroenzephalogr Elektromyogr Verwandte Geb. 1987 Mar;18(1):13–19. [PubMed] [Google Scholar]
  5. Elble R. J. Central mechanisms of tremor. J Clin Neurophysiol. 1996 Mar;13(2):133–144. doi: 10.1097/00004691-199603000-00004. [DOI] [PubMed] [Google Scholar]
  6. Elble R. J., Randall J. E. Mechanistic components of normal hand tremor. Electroencephalogr Clin Neurophysiol. 1978 Jan;44(1):72–82. doi: 10.1016/0013-4694(78)90106-2. [DOI] [PubMed] [Google Scholar]
  7. FitzGerald P. M., Jankovic J. Orthostatic tremor: an association with essential tremor. Mov Disord. 1991;6(1):60–64. doi: 10.1002/mds.870060111. [DOI] [PubMed] [Google Scholar]
  8. Gantert C., Honerkamp J., Timmer J. Analyzing the dynamics of hand tremor time series. Biol Cybern. 1992;66(6):479–484. doi: 10.1007/BF00204112. [DOI] [PubMed] [Google Scholar]
  9. Heilman K. M. Orthostatic tremor. Arch Neurol. 1984 Aug;41(8):880–881. doi: 10.1001/archneur.1984.04050190086020. [DOI] [PubMed] [Google Scholar]
  10. Hömberg V., Hefter H., Reiners K., Freund H. J. Differential effects of changes in mechanical limb properties on physiological and pathological tremor. J Neurol Neurosurg Psychiatry. 1987 May;50(5):568–579. doi: 10.1136/jnnp.50.5.568. [DOI] [PMC free article] [PubMed] [Google Scholar]
  11. Jenkins I. H., Bain P. G., Colebatch J. G., Thompson P. D., Findley L. J., Frackowiak R. S., Marsden C. D., Brooks D. J. A positron emission tomography study of essential tremor: evidence for overactivity of cerebellar connections. Ann Neurol. 1993 Jul;34(1):82–90. doi: 10.1002/ana.410340115. [DOI] [PubMed] [Google Scholar]
  12. Joyce G. C., Rack P. M. The effects of load and force on tremor at the normal human elbow joint. J Physiol. 1974 Jul;240(2):375–396. doi: 10.1113/jphysiol.1974.sp010615. [DOI] [PMC free article] [PubMed] [Google Scholar]
  13. McManis P. G., Sharbrough F. W. Orthostatic tremor: clinical and electrophysiologic characteristics. Muscle Nerve. 1993 Nov;16(11):1254–1260. doi: 10.1002/mus.880161117. [DOI] [PubMed] [Google Scholar]
  14. Papa S. M., Gershanik O. S. Orthostatic tremor: an essential tremor variant? Mov Disord. 1988;3(2):97–108. doi: 10.1002/mds.870030201. [DOI] [PubMed] [Google Scholar]
  15. Thompson P. D., Rothwell J. C., Day B. L., Berardelli A., Dick J. P., Kachi T., Marsden C. D. The physiology of orthostatic tremor. Arch Neurol. 1986 Jun;43(6):584–587. doi: 10.1001/archneur.1986.00520060048016. [DOI] [PubMed] [Google Scholar]
  16. Tsai C. H., Semmler J. G., Kimber T. E., Thickbroom G., Stell R., Mastaglia F. L., Thompson P. D. Modulation of primary orthostatic tremor by magnetic stimulation over the motor cortex. J Neurol Neurosurg Psychiatry. 1998 Jan;64(1):33–36. doi: 10.1136/jnnp.64.1.33. [DOI] [PMC free article] [PubMed] [Google Scholar]
  17. Uncini A., Onofrj M., Basciani M., Cutarella R., Gambi D. Orthostatic tremor: report of two cases and an electrophysiological study. Acta Neurol Scand. 1989 Feb;79(2):119–122. doi: 10.1111/j.1600-0404.1989.tb03722.x. [DOI] [PubMed] [Google Scholar]
  18. Walker F. O., McCormick G. M., Hunt V. P. Isometric features of orthostatic tremor: an electromyographic analysis. Muscle Nerve. 1990 Oct;13(10):918–922. doi: 10.1002/mus.880131006. [DOI] [PubMed] [Google Scholar]
  19. Wee A. S., Subramony S. H., Currier R. D. "Orthostatic tremor' in familial-essential tremor. Neurology. 1986 Sep;36(9):1241–1245. doi: 10.1212/wnl.36.9.1241. [DOI] [PubMed] [Google Scholar]
  20. Wills A. J., Jenkins I. H., Thompson P. D., Findley L. J., Brooks D. J. A positron emission tomography study of cerebral activation associated with essential and writing tremor. Arch Neurol. 1995 Mar;52(3):299–305. doi: 10.1001/archneur.1995.00540270095025. [DOI] [PubMed] [Google Scholar]
  21. Wills A. J., Thompson P. D., Findley L. J., Brooks D. J. A positron emission tomography study of primary orthostatic tremor. Neurology. 1996 Mar;46(3):747–752. doi: 10.1212/wnl.46.3.747. [DOI] [PubMed] [Google Scholar]

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