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Orthostatic tremor: current challenges and future prospects

Authors Adebayo P

Received 12 November 2015

Accepted for publication 9 February 2016

Published 6 April 2016 Volume 2016:6 Pages 17—24


Checked for plagiarism Yes

Review by Single anonymous peer review

Peer reviewer comments 3

Editor who approved publication: Prof. Dr. Thomas Müller

Philip Babatunde Adebayo

Neurology Unit, Department of Medicine, Faculty of Clinical Sciences, Ladoke Akintola University of Technology, Ogbomoso, Oyo State, Nigeria

Abstract: This review provides an outlook of orthostatic tremor (OT), a rare adult-onset tremor characterized by subjective unsteadiness during standing that is relieved by sitting or walking. Recent case series with a long-time follow-up have shown that the disease is slowly progressive, spatially spreads to the upper limbs, and other neurological disorders may develop in about one-third of the patients. The diagnosis of OT hinges on the typical history of unsteadiness during standing, which is confirmed by electromyographic findings of a 13–18 Hz tremor that is typically absent during tonic activation while the patient is sitting and lying. Although the tremor is generated by a central oscillator, cerebellar and/or basal ganglia dysfunction are needed for its manifestation (double lesion hypothesis). However, functional neuroimaging findings have not consistently implicated the dopaminergic system in its pathogenesis. Drug treatments have been largely disappointing with no sustained benefits, although thalamic deep brain stimulation has helped some patients. Large-scale follow-up studies, more drug trials, and novel therapies are urgently needed.

Keywords: orthostasis tremor, challenges, prospects, therapies, clinical course, drug trials

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