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Background Orthostatic Tremor (OT) is characterized by the presence of a sensation of instability while standing, associated with high frequency (13–18 Hz) lower extremity tremor. Diagnosis is confirmed with surface electromyography (EMG). An accurate screening tool that could be used in the routine clinical setting, without any specialized equipment, would be useful in earlier detection of OT and judicial use of additional testing. Objective The objective of this study was to evaluate OT diagnostic test characteristics at bedside using iPhone's built‐in accelerometer and available applications for tremor recordings. Methods We obtained recordings using iPhones (Model 5, 5s, and 6) and free Applications (“LiftPulse” by LiftLabs [App1] and “iSeismometer” by ObjectGraph LLC [App2]) at default settings. Results 24 EMG‐confirmed OT subjects (mostly females, 22/24) and 15 age‐matched controls (mostly males, 11/15) were evaluated. App1 detected OT range tremor in 22/24 patients and none of the controls. (Sensitivity = 92%, Specificity = 100%, NPV = 88%). App2 detected OT range tremor in 21/24 patients and in 1/13 controls (Sensitivity = 88%, Specificity = 92%, NPV = 80%). When combined, 24/24 patients and 1/13 controls had OT range tremor (Sensitivity = 100%, Specificity = 92%, NPV = 100%). Conclusions Smartphone apps that use the built‐in accelerometer provide a simple, accurate and inexpensive bedside screening diagnostic tool for patients with OT.

Blepharospasm is a focal dystonia characterized by involuntary closure of the eyelids [Stacy, 2007]. It usually affects both orbicularis oculi, and can progress into causing significant disability. It may occur in isolation, or be associated with other dystonias. Parkinsonism, dystonic cerebral palsy, and tardive phenomena are some of the commonly associated disorders. Adequate treatment of blepharospasm is necessary to allow maintenance of quality of life, avoid functional blindness, and to prevent complications such as corneal abrasions and dermatochalasis. In 1989, blepharospasm (in patients older than 12 years old) was the first indication approved by the United States Food and Drug Administration (FDA) for the use of BoNT-A [Ramirez-Castaneda and Jankovic, 2013]. Before the introduction of chemodenervation through botulinum neurotoxin (BoNT) injections, treatment was challenging, as oral medications had minimal effectiveness and produced limiting side effects. We provide here an up-todate review of the use of BoNT for blepharospasm. Epidemiology Prevalence estimates of blepharospasm range from 16-133 cases per million [Defazio and

The fractal analysis of stride-to-stride fluctuations in walking has become an integral part of human gait research. Fractal analysis of stride time intervals can provide insights into locomotor function and dysfunction, but its application requires a large number of strides, which can be difficult to collect from people with movement disorders such as Parkinson’s disease. It has recently been suggested that “stitching” together short gait trials to create a longer time series could be a solution. The objective of this study was to determine if scaling exponents from “stitched” stride time series were similar to those from continuous, longer stride time series. Fifteen young adults, fourteen older adults, and thirteen people with Parkinson’s disease walked around an indoor track in three blocks: one time 15 min, five times 3 min, and thirty times 30 s. Stride time intervals were determined from gait events recorded with instrumented insoles, and the detrended fluctuation analysis was applied to each stride time series of 512 strides. There was no statistically significant difference between scaling exponents in the three blocks, but intra-class correlation revealed very low between-blocks reliability of scaling exponents. This result challenges the premise that the stitching procedure could provide reliable information about gait dynamics, as it suggests that fractal analysis of stitched time series does not capture the same dynamics as gait recorded continuously. The stitching procedure cannot be considered as a valid alternative to the collection of continuous, long trials. Further studies are recommended to determine if the application of fractal analysis is limited by its own methodological considerations (i.e., long time series), or if other solutions exists to obtain reliable scaling exponents in populations with movement disorders.

Background: The exact pathophysiology of primary Orthostatic Tremor (OT) is unknown. A central oscillator is assumed, and previous imaging studies show involvement of cerebellar pathways. However, the presence of ataxia on clinical exam is disputed. We set out to study ataxia in OT prospectively. Methods: EMG-confirmed primary OT subjects and spousal controls received a neurological exam with additional semiquantitative evaluations of ataxia as part of a multinational, prospective study. These included detailed limb coordination (DLC), detailed stance and gait evaluation (DS), and the Brief Ataxia Rating Scale (BARS). Intra- and inter-rater reliability were assessed and satisfactory. Results: 34 OT subjects (mean age = 67 years, 88% female) and 21 controls (mean age = 66 years, 65% male) were enrolled. Average disease duration was 18 years (range 4–44). BARS items were abnormal in 88% of OT patients. The OT subjects were more likely to have appendicular and truncal ataxia with significant differences in DLC, DS and BARS. Ocular ataxia and dysarthria were not statistically different between the groups. Discussion: Mild-to-moderate ataxia could be more common in OT than previously thought. This is supportive of cerebellar involvement in the pathophysiology of OT. We discuss possible implications for clinical care and future research. Highlights: Previous studies of Primary Orthostatic Tremor (OT) have proposed pathophysiologic involvement of the cerebellar pathways. However, presence of ataxia has not been systematically studied in OT. This is a prospective comprehensive ataxia assessment in OT compared to controls. Mild-to-moderate appendiculo-truncal ataxia was found to be common in OT.

Objectives: To consider the impact of juvenile Huntington disease (JHD) from a biomedical, symptom burden, and total pain palliative care perspective. Methods: This case report was informed by a narrative review of the literature with inclusion of expert opinion from pediatric palliative care, an adult and pediatric neurologist, and a child psychiatrist. Audio-recorded qualitative interview and coauthorship with the pediatric patient's primary caregiver (his mother). Results: The JHD impacts all domains of child and family function. Significance of Results: Application of the concept of total pain to JHD informs and guides care for this complex, challenging condition.

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