Orthostatic Tremor

In this video, we'll overview Orthostatic Tremor or Shaky Legs Syndrome.

[@suzannes1625]

Thank you for spreading awareness of OT. I have this frustrating condition and you are right, it does significantly impact my daily life. I am female and 67. It took many years to be diagnosed and so far I have refused medication while it is trial and error due to limited research and understanding of the condition. September is Orthostatic Tremor awareness month and I have shared your video with my family and friends in the hope that it helps people understand why I have trouble doing simple things like writing or having a conversation unless I am sitting or leaning on something. My brain is concentrating on keeping me upright while standing, all the time dealing with the super fast, almost invisible movement in my leg muscles. The only time I feel “normal” is when I sit, walk quickly or lie down. Thankfully I can still walk and ride a bike, just don’t ask me to stop and chat with you.

[@myrtleesther8855]

I am the same. Had it for 12 years but its bad now can only stand for few seconds before tremor and instability sets in

[@JenniferPeterson-zz4fc]

Very instructive video, thank you. It gave me a better understanding of my husband’s condition.

[@whereisthehall]

Nice lecture it covered the rare topic and always interesting to listen. Most delightful to hear like other lectures due very clear scientific presentation.

[@puerco567]

Interesting information.

[@RobinPalmerTV]

This occurred to me as a huge cluster of neurological symptoms secondary to SIH due to a spinal CSF leak. I think this needs to be considered too since sx largely vanish when the patient is lying completely flat, and of course go away completely once the leak/fluid balance has normalised.

[@DrSimonFreilich]

Many thanks for sharing that Robin, and yes, a variety of movement disorders are indeed described as a result of SIH caused by CSF leaks.

[@RobinPalmerTV]

@@DrSimonFreilich I think most secondary HA types seem to cause this type of tremor. See also chiari malformations.

[@kathib1755]

Dr. Freilich, thank you so much for taking the time to make this very informative video about this rare disease. I was diagnosed with OT by a very competent Neurologist. However my EMG registered 6 Hz. I was tested again by another Neurologist with the same EMG reading, and she said I did not have OT because the EMG needs to be between 13-16 Hz. I have all the symptoms of OT and it has been quite disabling. I've read about "Slow OT" with readings

[@DrSimonFreilich]

Hi Kathi, thank you. I can't really comment specifically, but broadly speaking, whilst OT has its characteristic range of fast frequencies, there is an overlapping range of lower frequencies that occurs across a spectrum of other causes of tremor. 6Hz is at quite an intersection of different potential causes of tremor (which can all be quite limiting in of themselves). Probably the most common at 6Hz is essential tremor, which can also be worsened by movement and changes in posture. Other clinical features need to be taken into account to try and work out which one you have. So a Neurologist with an interest in movement disorders is your best way forward. Not quite the answer your seeking, but it's a complex area. Bw Simon

[@kathib1755]

Thank you SO much for taking the time to answer my question. I will look for a Movement Disorder specialist. Your help was very appreciated!

[@nishanthsampath478]

Great video. Could you please explain which muscle(s) you use to record the tremors from the lower limb?

[@DrSimonFreilich]

Hi Nisanth and a great question. I use the rectus femoris as a 'load bearing' muscle and its very sensitive in picking up the tremor very quickly. I know that others use TA +/-Gastroc. Bw Simon

[@MrGrammargod]

Can damage or long term dynamic compression to the lower trunk of the brachial plexus present as isolated hypothenar and first dorsal interosseous atrophy (similar to an ulnar nerve lesion) with sparing of the thenar eminence?

[@DrSimonFreilich]

Not that I am aware of. Bw Simon

[@TheDanchickPro]

i am 22 and i suffer from it since 6-7 years old

[@jemimanorman9841]

I have it for 20 years.

[@pixie89]

👍

[@nagireddikrishnaveni7678]

Revered Sir , May I know that How to perform Nerve Conduction Study for Long Thoracic Nerve at respective placements ?. Can you please share video or any inputs to get clarification Thank You Sir Krishnaveni

[@DrSimonFreilich]

Hi Nagireddi, I only do EMG of the Serratus and no NCS, so can't advise more than that. V best, Simon

[@nagireddikrishnaveni7678]

Ok thank You Sir

[@posturebalanceandfitness8429]

I have 2 patients who have experienced OT a few weeks after 2nd c jab....

[@DrSimonFreilich]

Surprising, was that with a measured tremor?

[@posturebalanceandfitness8429]

@@DrSimonFreilich only by stethoscope

[@posturebalanceandfitness8429]

@@DrSimonFreilich they were only recently diagnosed, however. As you said, many primary care doctors are not familiar with this.

[@DrSimonFreilich]

Thx!

[@poliveros55]

Just saw a patient with OT. He has persistent bilateral shoulder pain not responding to PT and subacromial injections. Is the shoulder pain related to the OT?