Abstract
Orthostatic tremor (OT) is a rare movement disorder characterized by high-frequency
(13–18 Hz) tremor in the legs and trunk during standing and relieved by sitting or
walking. While OT is frequently an isolated disorder, some patients may have comorbid
neurological conditions, such as essential tremor and parkinsonism, the so-called
OT Plus. The pathophysiology of OT is not well-understood, and a specific central
oscillator remains elusive, but current evidence suggests that ascending spinocerebellar
and proprioceptive inputs, cerebellar processing, cerebello–thalamo–cortical signals,
and cortico–muscular coupling play a role in the pathophysiology of OT, suggesting
that this is a network disorder. The treatment of OT is challenging, but pharmacological
therapy includes gabapentin, clonazepam, perampanel, and levodopa. While spinal cord
stimulation seems promising for selected patients, deep brain stimulation is mainly
employed in severe cases, resulting in modest improvement in standing tolerance.
Keywords
orthostatic tremor - shaky legs - essential tremor - deep brain stimulation
