Orthostatic tremor: a review of 45 cases

Parkinsonism Relat Disord. 2014 Jul;20(7):723-5. doi: 10.1016/j.parkreldis.2014.03.013. Epub 2014 Mar 21.


Objective: To evaluate the clinical characteristics, associated features, and treatment response of a large orthostatic tremor series seen over a 26-year period.

Methods: We reviewed the medical records of 45 patients seen between 1987 and 2013 who fulfilled the diagnostic criteria for orthostatic tremor.

Results: The mean age at onset was 59.5 years and 23/45 (51%) were men. A family history of any tremor was noted in 23/45 (51%) patients. A family history of orthostatic tremor was reported in 3/45 (7%) patients. 40/45 (89%) had primary orthostatic tremor with (n = 30) or without (n = 10) an associated postural arm tremor. We found that 5/45 (11%) had orthostatic tremor plus additional neurological features. One patient was diagnosed with dementia with Lewy bodies preceded by orthostatic tremor for 20 years. Prospective follow-up data was available for 30/45 patients and averaged 54.4 months. Treatment response to medications was modest and inconsistent. In 11/30 cases, orthostatic tremor worsened over the follow-up period. One patient with primary orthostatic tremor underwent thalamic deep brain stimulation surgery.

Conclusions: In our population of orthostatic tremor patients, mild postural hand tremor was a frequent finding. Over half of our patients had a family history of tremor, but a family history of orthostatic tremor was uncommon. Additional neurological features were seen in the minority of patients and we report possibly the first case of dementia with Lewy bodies associated with orthostatic tremor. Our series is the largest series of orthostatic tremor reported in the literature and contributes to understanding the clinical characteristics of this rare disease.

Keywords: Essential tremor; Orthostatic tremor; Tremor.

Publication types

  • Review

MeSH terms

  • Adult
  • Aged
  • Amines / therapeutic use
  • Clonazepam / therapeutic use
  • Cyclohexanecarboxylic Acids / therapeutic use
  • Deep Brain Stimulation / methods
  • Dizziness / diagnosis*
  • Dizziness / physiopathology
  • Dizziness / therapy*
  • Female
  • Gabapentin
  • Humans
  • Male
  • Middle Aged
  • Retrospective Studies
  • Tremor / diagnosis*
  • Tremor / physiopathology
  • Tremor / therapy*
  • gamma-Aminobutyric Acid / therapeutic use


  • Amines
  • Cyclohexanecarboxylic Acids
  • gamma-Aminobutyric Acid
  • Clonazepam
  • Gabapentin

Supplementary concepts

  • Primary orthostatic tremor