Symptomatic orthostatic tremor in pontine lesions

Benito‐León, Julián; Rodríguez, Javier; Ortı́-Pareja, M; Ayuso-Peralta, L; Jiménez-Jiménez, F. J.; Molina, José Antonio

doi:10.1212/wnl.49.5.1439

Cited by 79 publications

(57 citation statements)

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“…20 In addition, OT associated with a pontine lesion was described. 7 Recently, 2 patients with OT after head trauma were described. 10,11 However, not all of these patients had typical OT as some of them displayed a lower frequency than the typical 14 to 18 Hz bursts (for example, Cases 7 and 8 in Gabellini and colleagues, 1990; Case 1 in Benito-Leon and coworkers, 1997).…”

Section: Discussionmentioning

confidence: 99%

“…However, there have been rare reports of patients in whom OT was associated with other features, for instance, postural tremor of the arms 1-4 and Parkinson's disease (PD). 5,6 Also, OT has rarely been described in patients with pontine lesions, 7 cerebellar degeneration, 8,9 or after head trauma. 10,11 These reports could be considered forms of symptomatic OT.…”

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confidence: 99%

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Natural history and syndromic associations of orthostatic tremor: A review of 41 patients

et al. 2004

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Orthostatic tremor (OT) is a rare condition characterized by unsteadiness when standing still that is relieved when sitting or walking and is thought to arise from a central generator in the cerebellum or brainstem. OT is considered to be a distinct, discrete condition, and little is known about its demographic characteristics, natural history, associated features, and treatment response. We have reviewed these aspects in 41 OT patients fulfilling current diagnostic criteria, seen at our institution between 1986 and 2001. We classified 31 (75%) as having idiopathic "primary OT" either with (n = 24) or without an associated postural arm tremor. We found that 10 of 41 (25%) cases had additional neurological features, and we defined this group as having "OT plus" syndrome. Of these 10, 6 had parkinsonism; 4 of these had typical Parkinson's disease (PD), 1 had vascular and 1 had drug-induced parkinsonism. Among the remaining 4 patients, 2 had restless legs syndrome (RLS), 1 had tardive dyskinesia, and 1 orofacial dyskinesias of uncertain etiology. One patient with PD and the patient with vascular parkinsonism also had RLS. Age at onset was significantly earlier in the "primary OT" (mean +/- SD, 50.4 +/- 15.1) than in the "OT plus" (61.8 +/- 6.4; z = 2.7; P =.006) group. In 7 of the 10 "OT plus" patients, OT leg symptoms preceded the onset of additional neurological features. OT appeared to be underdiagnosed, and on average, it took 5.7 years from the initial complaints until a diagnosis was made. In general, treatment response to a variety of drugs such as clonazepam, primidone, and levodopa was poor. In most cases, OT symptoms remain relatively unchanged over the years, but in 6 of 41 cases (15%), the condition gradually worsened over the years, and in some of these cases, symptoms spread proximally to involve the trunk and arms. OT may not be a discrete disorder as commonly believed and associated features like parkinsonism present in nearly 25% of cases. Dopaminergic dysfunction may have a role in the pathophysiology of this disorder.

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Section: Discussionmentioning

confidence: 99%

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confidence: 99%

Natural history and syndromic associations of orthostatic tremor: A review of 41 patients

et al. 2004

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“…1 b). Symptomatic OT in patient B caused by a small unilateral cerebellar lesion seems unlikely although cerebellar dysfunction and pontine lesions have been described [4,5]. In both patients the imaging of striatal DAT ([ 123 I]FP-CIT-SPECT) and dopamine D 2 /D 3 receptors ([ 123 I]IBZM-SPECT), performed as described previously [15], showed ratios for specific uptake well within the range of healthy subjects indicating normal function of nigrostriatal dopaminergic systems.…”

Section: Florianmentioning

confidence: 98%

“…OT has been suggested to arise from a central oscillator involving the brainstem or cerebellum [4][5][6][7]. Interestingly, neuropathological changes in essential tremor have also been found in brainstem and cerebellar structures [8].…”

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Intact serotonergic and dopaminergic systems in two cases of orthostatic tremor

et al. 2008

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“…Neurological examination re-OT is a rare clinical syndrome in which a rapid (14-16 Hz) regular lower limb tremor causes unsteadiness on standing that is relieved when sitting or walking. OT is generally considered to be an idiopathic disorder (primary OT), although it has also been described in patients with Parkinson's disease, hydrocephalus, pontine lesions, head trauma and cerebellar degeneration [4][5][6] . A positron emission tomography study in primary OT suggested increased blood fl ow in the cerebellum bilaterally and in the thalamus and lentiform nuclei contralateral to an arm with 16-Hz tremor, suggesting involvement of the cerebellum [7] .…”

Section: Case Reportmentioning

confidence: 99%