In normal conditions, no one needs a second thought before standing upright. It is naturally convenient for healthy people but not for all. A specific type of tremor, “Orthostatic tremor”, can make simply standing upright for a few minutes an unpleasant and exhausting experience. This could be due to the intense feeling of being shaky, unstable or vibrating.
All of these frequently cease immediately when the patient sits down, walks, or leans against a supporting surface. Orthostatic tremor is very similar to other neurologic and balancing conditions in terms of symptoms. Therefore, the condition leads to many patients suffering from the illness for many years without correct diagnosis.
That is the reason why the correct diagnosis is so important, as without it, picking the right treatment is impossible. Despite the rareness of the disorder, the therapy may prove effective in facilitating mobility and reducing the symptoms of the disease.
Understanding ways of diagnosing and treating orthostatic tremor can help you make informed decisions about your health.
What is Orthostatic Tremor?
Orthostatic tremor (OT) is a very rare disorder of neurological movement. It is characterized by involuntary and rhythmic muscular contractions, occurring specifically when the patient stands up.
Unlike many other tremors that occur during movement or at rest, orthostatic tremor happens only when standing, making tremor treatment important for managing symptoms.
The tremor occurs very rapidly, usually with a frequency of 13-18 Hz. It's hard to observe it with the naked eye. Instead, the patient feels vibrations, a lack of strength or instability in their legs.
All symptoms usually disappear instantly if the patient:
Sits down
Begins to walk
Gets support against the wall
Takes weight off their legs
Symptoms
The development of symptoms is normally gradual and can get worse over time. These could be:
Unsteadiness when standing
Trembling quickly in both legs
Vibration sensation in the thighs and calves
Unable to stand in line
Fear of falling down
Difficulty walking
Feeling tired after standing for long
While the legs are mainly affected, some people may have tremors in their trunk and arms.
Diagnosing Orthostatic Tremor
A diagnosis of orthostatic tremor may be difficult to make. The primary reason is that the symptoms of this condition often mimic other conditions, such as anxiety disorders or Parkinson's disease. Experts diagnose the condition in the following ways.
Medical History
The first step in diagnosing the condition is always a discussion of symptoms with the patient. The specialist will ask:
When do symptoms appear?
Do symptoms get better during walking?
How long does it take the patient to stand before experiencing symptoms?
Are there any falls?
Is there a family history of neurologic conditions?
Physical And Neurological Examination
In the process of examination, the neurologist assesses the patient's:
Balance
Strength
Coordination
Reflexes
Gait
Posture
The physician may instruct the patient to stand still for some time in order to notice the onset of symptoms.
Electromyography (EMG)
Electromyography (EMG) is the gold standard in the diagnosis of orthostatic tremor.
It is a special technique aimed at recording the electrical activity of the muscles in the standing position. EMG is capable of detecting the high-frequency muscle twitching that is the hallmark of orthostatic tremor.
Accelerometry
Some specialized movement disorder clinics use accelerometers to detect vibrations and determine tremor frequency. Such tests assist in the diagnosis through objective measurement of muscular movements.
Brain Imaging
Magnetic resonance imaging (MRI) can be greatly helpful to rule out other neurological disorders that could present with such symptoms. MRI is usually normal in patients with primary orthostatic tremor, but it helps exclude any brain abnormalities.
Blood Tests
The purpose of running the blood tests is to rule out some metabolic or systemic disorders that could cause tremors. They may include:
Thyroid disorders
Vitamin deficiencies
Electrolyte imbalances
Autoimmune disorders
Treatment Options
At present, there is no specific therapy that can treat orthostatic tremor. The main goal is to relieve its symptoms, improve stability, and maintain independence. The management is personalized and based on the severity of the symptoms and needs of everyday life. The following are some ways.
Medications
Medications are the primary treatment option. Some effective medicines in this regard are
Clonazepam
Clonazepam is believed to be the most widely used drug in the case of orthostatic tremor. It helps decrease tremor intensity and gives people an opportunity to stand longer. Some side effects include:
Drowsiness
Dizziness
Fatigue
Memory loss in some cases
Gabapentin
This drug is helpful in most cases. Doctors count on it especially when a person does not get a good effect from clonazepam. Patients claim significant improvement in their symptoms.
Other Drugs
Apart from these two drugs, a neurologist may recommend:
Primidone
Pregabalin
Levetiracetam
Propranolol ( not effective in all cases)
Physical Therapy
Physical therapy can improve mobility and prevent falls. In tremor treatment, physical therapy always remains helpful. Regarding orthostatic tremor, it may include:
Balance exercises
Strengthening exercises
Gait exercises
Postural exercises
Coordinative exercises
While physical therapy cannot cure the tremor, it will certainly make patients feel more confident.
Occupational Therapy
Occupational therapists provide various strategies for performing daily tasks safely.
They can suggest:
Energy conservation techniques
Scheduled rests
Special equipment
Changes in home and workplace settings
Assistive Devices
Certain individuals may benefit from supportive devices that will enhance their balance while standing.
The options include:
Walking sticks
Walking frames
Rollators
Grab bars at home
Shower chairs
Proper use of supportive devices helps to overcome the fear of falling.
Lifestyle Modifications
Small changes in lifestyle can make a difference to the symptoms.
They include:
Don’t stand motionless for a long time
Sit down if necessary when performing some actions
Stand on each leg alternately
Rely on something stable when required
Stay active
Maintain normal weight
Get enough sleep
Consume moderate amounts of caffeine.
Plan activity around the symptoms to avoid fatigue.
Deep Brain Stimulation
Sometimes, in case of ineffective treatment with medications or other strategies, patients find deep brain stimulation DBS surgery a viable solution. Surgeons implant electrodes in certain areas of the brain involved in regulating movements. DBS can reduce tremors, but it is a brain surgery and carries risks including infection and bleeding.
Conclusion
Orthostatic tremor is a very uncommon movement disorder of the nervous system that causes problems in standing still. Since the symptoms of this condition overlap with the symptoms of many other neurological disorders, a correct diagnosis is a must.
A neurologist may run various tests for the right diagnosis. EMG confirms the diagnosis; imaging and blood tests rule out the other causes.
There is no known cure yet, but there are many ways to reduce the symptoms. They involve medication, along with physical therapy, occupational therapy, special equipment, and changes in everyday routines. If any of these is not effective, deep brain stimulation surgery is still a hope.
