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Grippe T, Fasano A, Chen R. Different types of tremor and myoclonus in an atypical case of shaking upon standing. Parkinsonism Relat Disord 2023; 111:105175. [PMID: 37271568 DOI: 10.1016/j.parkreldis.2022.09.014] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/08/2022] [Revised: 08/22/2022] [Accepted: 09/21/2022] [Indexed: 06/06/2023]
Abstract
Shaking upon standing is associated with a spectrum of different conditions. We describe an unusual case with a combination of slow orthostatic tremor, orthostatic myoclonus, and parkinsonism. The case illustrates the utility of electrophysiology for precise characterization of physical findings to establish the diagnosis.
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Affiliation(s)
- Talyta Grippe
- Edmond J. Safra Program in Parkinson's Disease, Morton and Gloria Shulman Movement Disorders Clinic, Toronto Western Hospital, UHN, Toronto, Ontario, Canada; Neuroscience Graduate Program, Federal University of Minas Gerais, Belo Horizonte, Brazil; Division of Neurology, University of Toronto, Toronto, Ontario, Canada
| | - Alfonso Fasano
- Edmond J. Safra Program in Parkinson's Disease, Morton and Gloria Shulman Movement Disorders Clinic, Toronto Western Hospital, UHN, Toronto, Ontario, Canada; Krembil Brain Institute, Toronto, Ontario, Canada; Center for Advancing Neurotechnological Innovation to Application (CRANIA), Canada; Department of Parkinson's Disease & Movement Disorders Rehabilitation, Moriggia-Pelascini Hospital - Gravedona ed Uniti, Como, 22015, Italy; Division of Neurology, University of Toronto, Toronto, Ontario, Canada
| | - Robert Chen
- Edmond J. Safra Program in Parkinson's Disease, Morton and Gloria Shulman Movement Disorders Clinic, Toronto Western Hospital, UHN, Toronto, Ontario, Canada; Krembil Brain Institute, Toronto, Ontario, Canada; Center for Advancing Neurotechnological Innovation to Application (CRANIA), Canada; Division of Neurology, University of Toronto, Toronto, Ontario, Canada.
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Tai YC, Kuo HC, Wu Y, Hsu SP. Orthostatic myoclonus - A retrospective study of Asian patients. J Formos Med Assoc 2021; 121:1310-1316. [PMID: 34656403 DOI: 10.1016/j.jfma.2021.09.019] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/02/2021] [Revised: 08/10/2021] [Accepted: 09/27/2021] [Indexed: 10/20/2022] Open
Abstract
BACKGROUND/PURPOSE Orthostatic myoclonus (OM) is myoclonic jerks in both legs during standing. It may relate to gait unsteadiness and may be associated with various diagnoses, including neurodegenerative, systemic, and musculoskeletal diseases. Diagnosis is based on the surface electromyography (SEMG). METHODS From January 2016 to June 2020, we retrospectively reviewed 35 patients diagnosed with OM based on the SEMG criteria and analyzed the electrophysiological data. RESULTS The mean age was 75.3±8.9. Disease duration ranged from 2 days to several years. Genders were equally affected. The most common symptom was gait disturbance, and the next was leg tremulous sensation, followed by backward disequilibrium. 28.6% of our patients had falls. Electrophysiologically, bursting duration shorter than 100 ms supported the myoclonic origin from the cortex. The bursting activity occurred only on the upright and weight-bearing leg. The associated diagnoses included lumbosacral radiculopathy (28.6%), lumbosacral radiculopathy plus myasthenia gravis (2.9%), lumbosacral radiculopathy plus vascular parkinsonism (5.7%), diabetic polyneuropathy (5.7%), vascular parkinsonism (17.1%), Parkinson's disease (PD) (14.2%), normal pressure hydrocephalus (5.7%), medication-induced parkinsonism (2.9%), cervical myelopathy (2.9%), medication-related myoclonus (2.9%), and unknown (11.4%). In PD, OM was present before, along with, or after PD diagnosis. The myoclonic activity disrupted the parkinsonian tremor upon standing on SEMG. CONCLUSION OM is a syndrome instead of a diagnosis. It is more prevalent in the elderly with gait disturbance and patients will not necessarily fall. It is associated with central and peripheral nerve system disorders, systemic diseases, and medication use. We hypothesize that OM is a pathological disintegration of motor circuit.
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Affiliation(s)
- Yi-Cheng Tai
- Department of Neurology, E-DA Hospital /I-Shou University, Kaohsiung, Taiwan
| | - Hung-Chang Kuo
- Department of Neurology, E-DA Cancer Hospital/I-Shou University, Kaohsiung, Taiwan
| | - Yihui Wu
- Department of Infectious Diseases, Pingtung Christian Hospital, Pingtung, Taiwan
| | - Shih-Pin Hsu
- Department of Neurology, E-DA Hospital /I-Shou University, Kaohsiung, Taiwan; School of Medicine, I-Shou University, Kaohsiung, Taiwan.
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The diagnostic value of clinical neurophysiology in hyperkinetic movement disorders: A systematic review. Parkinsonism Relat Disord 2021; 89:176-185. [PMID: 34362669 DOI: 10.1016/j.parkreldis.2021.07.033] [Citation(s) in RCA: 17] [Impact Index Per Article: 5.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/02/2020] [Revised: 07/27/2021] [Accepted: 07/28/2021] [Indexed: 01/24/2023]
Abstract
INTRODUCTION To guide the neurologist and neurophysiologist with interpretation and implementation of clinical neurophysiological examinations, we aim to provide a systematic review on evidence of electrophysiological features used to differentiate between hyperkinetic movement disorders. METHODS A PRISMA systematic search and QUADAS quality evaluation has been performed in PubMed to identify diagnostic test accuracy studies comparing electromyography and accelerometer features. We included papers focusing on tremor, dystonia, myoclonus, chorea, tics and ataxia and their functional variant. The features were grouped as 1) basic features (e.g., amplitude, frequency), 2) the influence of tasks on basic features (e.g., entrainment, distraction), 3) advanced analyses of multiple signals, 4) and diagnostic tools combining features. RESULTS Thirty-eight cross-sectional articles were included discussing tremor (n = 28), myoclonus (n = 5), dystonia (n = 5) and tics (n = 1). Fifteen were rated as 'high quality'. In tremor, the basic and task-related features showed great overlap between clinical tremor syndromes, apart from rubral and enhanced physiological tremor. Advanced signal analyses were best suited for essential, parkinsonian and functional tremor, and cortical, non-cortical and functional jerks. Combinations of electrodiagnostic features could identify essential, enhanced physiological and functional tremor. CONCLUSION Studies into the diagnostic accuracy of electrophysiological examinations to differentiate between hyperkinetic movement disorders have predominantly been focused on clinical tremor syndromes. No single feature can differentiate between them all; however, a combination of analyses might improve diagnostic accuracy.
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Muñoz-Delgado L, Macías-García D, Jesús S, Adarmes-Gómez A, Palomar FJ, Carrillo F, Mir P. Orthostatic Myoclonus Secondary to Central Pontine Myelinolysis. Mov Disord Clin Pract 2020; 7:335-337. [PMID: 32258236 DOI: 10.1002/mdc3.12917] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/18/2019] [Revised: 02/12/2020] [Accepted: 02/16/2020] [Indexed: 11/09/2022] Open
Affiliation(s)
- Laura Muñoz-Delgado
- Unidad de Trastornos del Movimiento, Servicio de Neurología y Neurofisiología Clínica, Instituto de Biomedicina de Sevilla, Hospital Universitario Virgen del Rocío/CSIC/Universidad de Sevilla Seville Spain
| | - Daniel Macías-García
- Unidad de Trastornos del Movimiento, Servicio de Neurología y Neurofisiología Clínica, Instituto de Biomedicina de Sevilla, Hospital Universitario Virgen del Rocío/CSIC/Universidad de Sevilla Seville Spain.,Centro de Investigación Biomédica en Red sobre Enfermedades Neurodegenerativas (CIBERNED) Spain
| | - Silvia Jesús
- Unidad de Trastornos del Movimiento, Servicio de Neurología y Neurofisiología Clínica, Instituto de Biomedicina de Sevilla, Hospital Universitario Virgen del Rocío/CSIC/Universidad de Sevilla Seville Spain.,Centro de Investigación Biomédica en Red sobre Enfermedades Neurodegenerativas (CIBERNED) Spain
| | - Astrid Adarmes-Gómez
- Unidad de Trastornos del Movimiento, Servicio de Neurología y Neurofisiología Clínica, Instituto de Biomedicina de Sevilla, Hospital Universitario Virgen del Rocío/CSIC/Universidad de Sevilla Seville Spain.,Centro de Investigación Biomédica en Red sobre Enfermedades Neurodegenerativas (CIBERNED) Spain
| | - Francisco J Palomar
- Unidad de Trastornos del Movimiento, Servicio de Neurología y Neurofisiología Clínica, Instituto de Biomedicina de Sevilla, Hospital Universitario Virgen del Rocío/CSIC/Universidad de Sevilla Seville Spain.,Centro de Investigación Biomédica en Red sobre Enfermedades Neurodegenerativas (CIBERNED) Spain
| | - Fátima Carrillo
- Unidad de Trastornos del Movimiento, Servicio de Neurología y Neurofisiología Clínica, Instituto de Biomedicina de Sevilla, Hospital Universitario Virgen del Rocío/CSIC/Universidad de Sevilla Seville Spain.,Centro de Investigación Biomédica en Red sobre Enfermedades Neurodegenerativas (CIBERNED) Spain
| | - Pablo Mir
- Unidad de Trastornos del Movimiento, Servicio de Neurología y Neurofisiología Clínica, Instituto de Biomedicina de Sevilla, Hospital Universitario Virgen del Rocío/CSIC/Universidad de Sevilla Seville Spain.,Centro de Investigación Biomédica en Red sobre Enfermedades Neurodegenerativas (CIBERNED) Spain
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Electrophysiological Investigations in Orthostatic Myoclonus: Preliminary Findings. Can J Neurol Sci 2017; 45:100-103. [PMID: 29110740 DOI: 10.1017/cjn.2017.241] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
We report the clinical and electrophysiological findings in seven patients with orthostatic myoclonus (OM) associated with gait initiation failure and falls. OM is one of the causes of unsteadiness of stance and gait, and it may develop as a symptom of neurodegenerative disorders. Both positive myoclonic bursts and negative myoclonus may be seen in electrophysiological recordings, and electrophysiological analysis suggests a subcortical origin for OM.
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Different orthostatic hyperkinesias go "Thump". Clin Neurophysiol Pract 2017; 2:144-146. [PMID: 30214987 PMCID: PMC6123872 DOI: 10.1016/j.cnp.2017.06.005] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/09/2017] [Accepted: 06/02/2017] [Indexed: 11/29/2022] Open
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Cutsforth-Gregory JK, Hammack JE, Matsumoto JY. Orthostatic myoclonus after brain tumor radiation: Insights from two lesional cases. Parkinsonism Relat Disord 2017; 41:109-112. [PMID: 28457650 DOI: 10.1016/j.parkreldis.2017.04.015] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/02/2017] [Revised: 04/10/2017] [Accepted: 04/25/2017] [Indexed: 11/28/2022]
Abstract
INTRODUCTION Orthostatic myoclonus (OM) is a recognized syndrome of gait unsteadiness accompanied by lower limb myoclonus provoked by the assumption of an upright posture. OM typically affects the elderly and is often associated with neurodegenerative disease. We sought to review the clinical and electrophysiologic characteristics of OM due to brain tumor treatment, the first reported lesional cases of this rare disorder. METHODS The database of the Mayo Clinic Rochester Movement Disorders Laboratory was searched for all patients diagnosed with OM from January 2007 to December 2016. All available clinical, radiographic, and surface electromyographic data were reviewed, and patients with a history of primary or metastatic brain tumor were analyzed. RESULTS Two patients with OM and brain tumor were identified; both had undergone tumor resection and targeted brain radiation. Both patients complained of unsteadiness while walking and recurrent falls. Tumor pathology (atypical meningioma, gliosarcoma) was centered in the frontal lobe and extended to the supplementary motor area (SMA), pre-SMA, or prefrontal cortex. Medications did not improve gait. CONCLUSION Two cases of brain tumor-related OM suggest that degeneration of frontal motor programming circuits underlies the pathophysiology of OM.
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Hassan A, van Gerpen JA. Orthostatic Tremor and Orthostatic Myoclonus: Weight-bearing Hyperkinetic Disorders: A Systematic Review, New Insights, and Unresolved Questions. TREMOR AND OTHER HYPERKINETIC MOVEMENTS (NEW YORK, N.Y.) 2017; 6:417. [PMID: 28105385 PMCID: PMC5233784 DOI: 10.7916/d84x584k] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 07/20/2016] [Accepted: 10/25/2016] [Indexed: 12/01/2022]
Abstract
BACKGROUND Orthostatic tremor (OT) and orthostatic myoclonus (OM) are weight-bearing hyperkinetic movement disorders most commonly affecting older people that induce "shaky legs" upon standing. OT is divided into "classical" and "slow" forms based on tremor frequency. In this paper, the first joint review of OT and OM, we review the literature and compare and contrast their demographic, clinical, electrophysiological, neuroimaging, pathophysiological, and treatment characteristics. METHODS A PubMed search up to July 2016 using the phrases "orthostatic tremor," "orthostatic myoclonus," "shaky legs," and "shaky legs syndrome" was performed. RESULTS OT and OM should be suspected in older patients reporting unsteadiness with prolonged standing and/or who exhibit cautious, wide-based gaits. Surface electromyography (SEMG) is necessary to verify the diagnoses. Functional neuroimaging and electrophysiology suggest the generator of classical OT lies within the cerebellothalamocortical network. For OM, and possibly slow OT, the frontal, subcortical cerebrum is the most likely origin. Clonazepam is the most useful medication for classical OT, and levetiracetam for OM, although results are often disappointing. Deep brain stimulation appears promising for classical OT. Rolling walkers reliably improve gait affected by these disorders, as both OT and OM attenuate when weight is transferred from the legs to the arms. DISCUSSION Orthostatic hyperkinesias are likely underdiagnosed, as SEMG is often unavailable in clinical practice, and thus may be more frequent than currently recognized. The shared weight-bearing induction of OT and OM may indicate a common pathophysiology. Further research, including use of animal models, is necessary to better define the prevalence and pathophysiology of OT and OM, in order to improve their treatment, and provide additional insights into basic balance and gait mechanisms.
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Affiliation(s)
- Anhar Hassan
- Department of Neurology, Mayo Clinic, Rochester, MN, USA
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Benito-León J, Domingo-Santos Á. Orthostatic Tremor: An Update on a Rare Entity. TREMOR AND OTHER HYPERKINETIC MOVEMENTS (NEW YORK, N.Y.) 2016; 6:411. [PMID: 27713855 PMCID: PMC5039949 DOI: 10.7916/d81n81bt] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 06/15/2016] [Accepted: 08/22/2016] [Indexed: 12/01/2022]
Abstract
Background Orthostatic tremor (OT) remains among the most intriguing and poorly understood of movement disorders. Compared to Parkinson’s disease or even essential tremor, there are very few articles addressing more basic science issues. In this review, we will discuss the findings of main case series on OT, including data on etiology, pathophysiology, diagnostic approach, treatment strategies, and outcome. Methods Data for this review were identified by searching PUBMED (January 1966 to August 2016) for the terms “orthostatic tremor” or “shaky leg syndrome,” which yielded 219 entries. We did not exclude papers on the basis of language, country, or publication date. The electronic database searches were supplemented by articles in the authors’ files that pertained to this topic. Results Owing to its rarity, the current understanding of OT is limited and is mostly based on small case series or case reports. Despite this, a growing body of evidence indicates that OT might be a progressive condition that is clinically heterogeneous (primary vs. secondary cases) with a broader spectrum of clinical features, mainly cerebellar signs, and possible cognitive impairment and personality disturbances. Along with this, advanced neuroimaging techniques are now demonstrating distinct anatomical and functional changes, some of which are consistent with neuronal loss. Discussion OT might be a family of diseases, unified by the presence of leg tremor, but further characterized by etiological and clinical heterogeneity. More work is needed to understand the pathogenesis of this condition.
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Affiliation(s)
- Julián Benito-León
- Department of Neurology, University Hospital "12 de Octubre", Madrid, Spain; Centro de Investigación Biomédica en Red sobre Enfermedades Neurodegenerativas (CIBERNED), Madrid, Spain; Department of Medicine, Complutense University, Madrid, Spain
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Gövert F, Witt K, Erro R, Hellriegel H, Paschen S, Martinez-Hernandez E, Wandinger KP, Deuschl G, Dalmau J, Leypoldt F. Orthostatic myoclonus associated with Caspr2 antibodies. Neurology 2016; 86:1353-1355. [PMID: 26944274 DOI: 10.1212/wnl.0000000000002547] [Citation(s) in RCA: 32] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/18/2015] [Accepted: 11/30/2015] [Indexed: 11/15/2022] Open
Affiliation(s)
- Felix Gövert
- From Christian-Albrecht University of Kiel (F.G., K.W., H.H., S.P., G.D., F.L.), Germany; University College London (UCL) Institute of Neurology (R.E.), UK; August Pi i Sunyer Biomedical Research Institute (IDIBAPS) (E.M.-H., J.D.), Hospital Clínic, University of Barcelona, Spain; Institute of Clinical Chemistry (K.P.-W.), University of Lübeck (K.P.-W.), Germany; University of Pennsylvania (J.D.), Philadelphia; Catalan Institution for Research and Advanced Studies (ICREA) (J.D.), Barcelona, Spain; and Neuroimmunology (F.L.), Institute of Clinical Chemistry, Christian-Albrecht University of Kiel, Germany
| | - Karsten Witt
- From Christian-Albrecht University of Kiel (F.G., K.W., H.H., S.P., G.D., F.L.), Germany; University College London (UCL) Institute of Neurology (R.E.), UK; August Pi i Sunyer Biomedical Research Institute (IDIBAPS) (E.M.-H., J.D.), Hospital Clínic, University of Barcelona, Spain; Institute of Clinical Chemistry (K.P.-W.), University of Lübeck (K.P.-W.), Germany; University of Pennsylvania (J.D.), Philadelphia; Catalan Institution for Research and Advanced Studies (ICREA) (J.D.), Barcelona, Spain; and Neuroimmunology (F.L.), Institute of Clinical Chemistry, Christian-Albrecht University of Kiel, Germany
| | - Roberto Erro
- From Christian-Albrecht University of Kiel (F.G., K.W., H.H., S.P., G.D., F.L.), Germany; University College London (UCL) Institute of Neurology (R.E.), UK; August Pi i Sunyer Biomedical Research Institute (IDIBAPS) (E.M.-H., J.D.), Hospital Clínic, University of Barcelona, Spain; Institute of Clinical Chemistry (K.P.-W.), University of Lübeck (K.P.-W.), Germany; University of Pennsylvania (J.D.), Philadelphia; Catalan Institution for Research and Advanced Studies (ICREA) (J.D.), Barcelona, Spain; and Neuroimmunology (F.L.), Institute of Clinical Chemistry, Christian-Albrecht University of Kiel, Germany
| | - Helge Hellriegel
- From Christian-Albrecht University of Kiel (F.G., K.W., H.H., S.P., G.D., F.L.), Germany; University College London (UCL) Institute of Neurology (R.E.), UK; August Pi i Sunyer Biomedical Research Institute (IDIBAPS) (E.M.-H., J.D.), Hospital Clínic, University of Barcelona, Spain; Institute of Clinical Chemistry (K.P.-W.), University of Lübeck (K.P.-W.), Germany; University of Pennsylvania (J.D.), Philadelphia; Catalan Institution for Research and Advanced Studies (ICREA) (J.D.), Barcelona, Spain; and Neuroimmunology (F.L.), Institute of Clinical Chemistry, Christian-Albrecht University of Kiel, Germany
| | - Steffen Paschen
- From Christian-Albrecht University of Kiel (F.G., K.W., H.H., S.P., G.D., F.L.), Germany; University College London (UCL) Institute of Neurology (R.E.), UK; August Pi i Sunyer Biomedical Research Institute (IDIBAPS) (E.M.-H., J.D.), Hospital Clínic, University of Barcelona, Spain; Institute of Clinical Chemistry (K.P.-W.), University of Lübeck (K.P.-W.), Germany; University of Pennsylvania (J.D.), Philadelphia; Catalan Institution for Research and Advanced Studies (ICREA) (J.D.), Barcelona, Spain; and Neuroimmunology (F.L.), Institute of Clinical Chemistry, Christian-Albrecht University of Kiel, Germany
| | - Eugenia Martinez-Hernandez
- From Christian-Albrecht University of Kiel (F.G., K.W., H.H., S.P., G.D., F.L.), Germany; University College London (UCL) Institute of Neurology (R.E.), UK; August Pi i Sunyer Biomedical Research Institute (IDIBAPS) (E.M.-H., J.D.), Hospital Clínic, University of Barcelona, Spain; Institute of Clinical Chemistry (K.P.-W.), University of Lübeck (K.P.-W.), Germany; University of Pennsylvania (J.D.), Philadelphia; Catalan Institution for Research and Advanced Studies (ICREA) (J.D.), Barcelona, Spain; and Neuroimmunology (F.L.), Institute of Clinical Chemistry, Christian-Albrecht University of Kiel, Germany
| | - Klaus-Peter Wandinger
- From Christian-Albrecht University of Kiel (F.G., K.W., H.H., S.P., G.D., F.L.), Germany; University College London (UCL) Institute of Neurology (R.E.), UK; August Pi i Sunyer Biomedical Research Institute (IDIBAPS) (E.M.-H., J.D.), Hospital Clínic, University of Barcelona, Spain; Institute of Clinical Chemistry (K.P.-W.), University of Lübeck (K.P.-W.), Germany; University of Pennsylvania (J.D.), Philadelphia; Catalan Institution for Research and Advanced Studies (ICREA) (J.D.), Barcelona, Spain; and Neuroimmunology (F.L.), Institute of Clinical Chemistry, Christian-Albrecht University of Kiel, Germany
| | - Günther Deuschl
- From Christian-Albrecht University of Kiel (F.G., K.W., H.H., S.P., G.D., F.L.), Germany; University College London (UCL) Institute of Neurology (R.E.), UK; August Pi i Sunyer Biomedical Research Institute (IDIBAPS) (E.M.-H., J.D.), Hospital Clínic, University of Barcelona, Spain; Institute of Clinical Chemistry (K.P.-W.), University of Lübeck (K.P.-W.), Germany; University of Pennsylvania (J.D.), Philadelphia; Catalan Institution for Research and Advanced Studies (ICREA) (J.D.), Barcelona, Spain; and Neuroimmunology (F.L.), Institute of Clinical Chemistry, Christian-Albrecht University of Kiel, Germany
| | - Josep Dalmau
- From Christian-Albrecht University of Kiel (F.G., K.W., H.H., S.P., G.D., F.L.), Germany; University College London (UCL) Institute of Neurology (R.E.), UK; August Pi i Sunyer Biomedical Research Institute (IDIBAPS) (E.M.-H., J.D.), Hospital Clínic, University of Barcelona, Spain; Institute of Clinical Chemistry (K.P.-W.), University of Lübeck (K.P.-W.), Germany; University of Pennsylvania (J.D.), Philadelphia; Catalan Institution for Research and Advanced Studies (ICREA) (J.D.), Barcelona, Spain; and Neuroimmunology (F.L.), Institute of Clinical Chemistry, Christian-Albrecht University of Kiel, Germany
| | - Frank Leypoldt
- From Christian-Albrecht University of Kiel (F.G., K.W., H.H., S.P., G.D., F.L.), Germany; University College London (UCL) Institute of Neurology (R.E.), UK; August Pi i Sunyer Biomedical Research Institute (IDIBAPS) (E.M.-H., J.D.), Hospital Clínic, University of Barcelona, Spain; Institute of Clinical Chemistry (K.P.-W.), University of Lübeck (K.P.-W.), Germany; University of Pennsylvania (J.D.), Philadelphia; Catalan Institution for Research and Advanced Studies (ICREA) (J.D.), Barcelona, Spain; and Neuroimmunology (F.L.), Institute of Clinical Chemistry, Christian-Albrecht University of Kiel, Germany.
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Four cases of orthostatic myoclonus. J Clin Neurosci 2016; 29:180-2. [PMID: 26916904 DOI: 10.1016/j.jocn.2015.12.026] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/15/2014] [Revised: 12/30/2015] [Accepted: 12/31/2015] [Indexed: 11/23/2022]
Abstract
Orthostatic unsteadiness (unsteadiness on standing) is a relatively common symptom and can have neurological or non-neurological causes. Glass et al. have recently described a syndrome presenting with unsteadiness or leg jerking during standing or gait initiation difficulty which they have termed orthostatic myoclonus (OM). OM is a disabling syndrome but potentially treatable. It may develop on the background of neurodegenerative disease; other causes include pro-myoclonic drugs such as tricyclic antidepressants. In order to increase awareness of this syndrome, we report four patients with electrophysiologically confirmed OM who were referred to the movement disorder unit for lower limb tremor studies. All four patients presented with unsteadiness on standing. There were no signs suggestive of neurodegenerative disease and three of the patients had a provisional diagnosis of orthostatic tremor. The diagnosis of OM was supported by a surface electromyography showing 9-16Hz, non-rhythmic muscle bursts with burst duration of 50-100ms during standing. OM is unrecognised by many physicians as a cause of orthostatic intolerance. The most common syndrome with which OM may be confused is orthostatic tremor. A correct diagnosis is important as it may respond to treatment with clonazepam, gabapentin or piracetam.
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Termsarasab P, Thammongkolchai T, Frucht SJ. Spinal-generated movement disorders: a clinical review. JOURNAL OF CLINICAL MOVEMENT DISORDERS 2015; 2:18. [PMID: 26788354 PMCID: PMC4711055 DOI: 10.1186/s40734-015-0028-1] [Citation(s) in RCA: 26] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 09/09/2015] [Accepted: 11/24/2015] [Indexed: 12/25/2022]
Abstract
Spinal-generated movement disorders (SGMDs) include spinal segmental myoclonus, propriospinal myoclonus, orthostatic tremor, secondary paroxysmal dyskinesias, stiff person syndrome and its variants, movements in brain death, and painful legs-moving toes syndrome. In this paper, we review the relevant anatomy and physiology of SGMDs, characterize and demonstrate their clinical features, and present a practical approach to the diagnosis and management of these unusual disorders.
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Affiliation(s)
- Pichet Termsarasab
- />Department of Neurology, Movement Disorder Division, Icahn School of Medicine at Mount Sinai, New York, USA
- />Department of Medicine, Neurology Division, Faculty of Medicine, Siriraj Hospital, Mahidol University, Bangkok, Thailand
| | | | - Steven J. Frucht
- />Department of Neurology, Movement Disorder Division, Icahn School of Medicine at Mount Sinai, New York, USA
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Erro R, Bhatia KP, Cordivari C. Shaking on Standing: A Critical Review. Mov Disord Clin Pract 2014; 1:173-179. [PMID: 30363785 DOI: 10.1002/mdc3.12053] [Citation(s) in RCA: 21] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/15/2014] [Revised: 04/19/2014] [Accepted: 04/24/2014] [Indexed: 11/06/2022] Open
Abstract
Orthostatic tremor is a rare condition, though its exact prevalence is unknown, which is clinically characterized by a feeling of unsteadiness or being about to fall on standing and which disappears on walking, sitting, or lying down. It is generally accepted that classic orthostatic tremor manifests with a high-frequency tremor (>13 Hz) of the legs when standing. However, a number of patients initially reported as orthostatic tremor did not actually have such electrophysiological features. It is our experience that there is a clinical spectrum of different conditions presenting as shaking on standing, and this highlights the importance of the electrophysiology to aid the differential diagnosis of these disorders. Here, we provide a critical review of the clinical spectrum of shaking on standing, along with demonstrative electrophysiological recordings of some of these conditions.
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Affiliation(s)
- Roberto Erro
- Sobell Department of Motor Neuroscience and Movement Disorders UCL Institute of Neurology London United Kingdom.,Dipartimento di Scienze Neurologiche e del Movimento Università di Verona Verona Italy.,Department of Clinical Neurophysiology National Hospital for Neurology and Neurosurgery, Queen Square London United Kingdom
| | - Kailash P Bhatia
- Sobell Department of Motor Neuroscience and Movement Disorders UCL Institute of Neurology London United Kingdom
| | - Carla Cordivari
- Department of Clinical Neurophysiology National Hospital for Neurology and Neurosurgery, Queen Square London United Kingdom
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