Figure 1
Surface EMG recording from lower limbs while the patient was standing. Recordings from Bilateral Quadriceps, Hamstrings, Gastrocnemius, and Tibialis Anterior revealed a 15–16 Hz Tremor with a Burst Duration of about 25 ms.
Figure 2
Surface EMG Recording of Right Wrist Extensors and Flexors while the Arm Was at Rest Revealed a 5 Hz Tremor. The 15–16 Hz recording obtained from the gastrocnemius and tibialis anterior establishes the presence of two different types of tremors.
Segment 1
Video demonstrating key clinical features and electrophysiological evaluation of the tremor. A rest tremor of the right upper limb, and no rest tremor of left upper limb or either lower limb. There is a mild postural tremor of right upper limb. The patient has asymmetrical bradykinesia, with the right affected more than the left. Upon standing, the patient stands with a broad base and develops a asymmetric tremor of the lower limbs (right>left). The tremor is not evident upon walking and she walks cautiously with reduction in bilateral arm swing.
Segment 2
Surface EMG Recording from Bilateral Quadriceps, Hamstrings, Gastrocnemius, and Tibialis Anterior while the Patient Was Standing Revealed a 15–16 Hz Tremor. An increase in amplitude can be observed with cognitive activation.
Table 1
Reports of Fast Orthostatic Tremor in Parkinson’s Disease
| Article | Number of Patients | Frequency of Tremor (Hz) | Chronology of Symptoms | Response of OT to Medication |
|---|---|---|---|---|
| Wills et al.6 | 1 | 14.5 | OT preceded PD | Good response to levodopa |
| Apartis et al.7 | 3 | 14–18 | 1 – OT preceded PD | Partial response to clonazepam |
| 2 – PD preceded OT | ||||
| Gerschlager et al.2 | 3 | 13–18# | 3 – OT preceded PD | 2 – Good response to levodopa |
| 1 – No response to propranolol (other details unavailable) | ||||
| Leu-Semenescu et al.8 | 4 | 13–18 | 4-PD preceded OT | 3 – Good response to clonazepam |
| 1 – Details unavailable | ||||
| Kang et al.9 | 1 | 16–17 | OT preceded PD | Treated with dopamine agonists and benztropine. Good response to medication. |
| Mestre et al.10 | 1 | 13–18* | OT preceded PD | Poor response of OT to levodopa |
| Hassan et al.11 | 6 | 12.5–20** | Details unavailable | Details unavailable** |
| Present study, 2019 | 1 | 15–16 | OT preceded PD | Poor response of OT to levodopa |
| Good response of OT to clonazepam |