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Myoclonus or tremor in orthostatism: An under‐recognized cause of unsteadiness in Parkinson's disease
Author(s) -
LeuSemenescu Smaranda,
Roze Emmanuel,
Vidailhet Marie,
Legrand AndréPierre,
Trocello JeanMarc,
Cochen Valérie,
Sangla Sophie,
Apartis Emmanuelle
Publication year - 2007
Publication title -
movement disorders
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 3.352
H-Index - 198
eISSN - 1531-8257
pISSN - 0885-3185
DOI - 10.1002/mds.21651
Subject(s) - myoclonus , orthostatic vital signs , clonazepam , parkinson's disease , physical medicine and rehabilitation , electromyography , medicine , movement disorders , postural tremor , neurological disorder , psychology , resting tremor , essential tremor , levodopa , central nervous system disease , anesthesia , physical therapy , disease , neuroscience , blood pressure
Patients with Parkinson's disease (PD) often complain of unsteadiness. This can occur as the result of various neurological dysfunctions, including changes in postural adjustments, loss of postural reflexes, axial akinesia and rigidity, freezing and/or postural hypotension. In some cases these symptoms remain unexplained, and rare cases of unsteadiness have been attributed to tremor on standing. To delineate this condition, we investigated 11 consecutive PD patients with unexplained unsteadiness because of tremor on standing, seen in our department over a 6‐year period. All the patients had detailed clinical and electrophysiological investigations based on surface polygraphic electromyographic recordings. Four patients had fast orthostatic tremor (13–18 Hz), one had intermediate orthostatic tremor (8–9 Hz), and three had slow orthostatic tremor (4–6 Hz). The remaining 3 patients had orthostatic myoclonus, a condition that has not previously been reported in PD. Patients with fast tremor improved on clonazepam. Patients with slow tremor and myoclonus improved on levodopa and sometimes benefited further when clonazepam was added. These observations show the usefulness of neurophysiological investigations for diagnosing and treating unexplained unsteadiness in Parkinson's disease. © 2007 Movement Disorder Society