Gait characterization for patients with orthostatic tremor

Opri, Enrico; Hu, Wei; Jabarkheel, Zakia; Hess, Christopher W.; Schmitt, Abigail C.; Gündüz, Ayşegül; Hass, Chris J.; Okun, Michael S.; Shukla, Aparna Wagle

doi:10.1016/j.parkreldis.2020.01.007

Cited by 6 publications

(6 citation statements)

References 13 publications

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“…The staggering wide-based mode of walking in patients with OT is representative of the phenotype of a cerebellar or sensory ataxic gait disorder [14,15]. Similar gait alterations have been reported in a recent publication [16]. Signs in our patients for cerebellar impairment coincide with previous reports [5,17].…”

Section: Discussionsupporting

confidence: 89%

The gait disorder in primary orthostatic tremor

et al. 2020

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Objective To uncover possible impairments of walking and dynamic postural stability in patients with primary orthostatic tremor (OT). Methods Spatiotemporal gait characteristics were quantified in 18 patients with primary OT (mean age 70.5 ± 5.9 years, 10 females) and 18 age-matched healthy controls. One-third of patients reported disease-related fall events. Walking performance was assessed on a pressure-sensitive carpet under seven conditions: walking at preferred, slow, and maximal speed, with head reclination or eyes closed, and while performing a cognitive or motor dual-task paradigm. Results Patients exhibited a significant gait impairment characterized by a broadened base of support (p = 0.018) with increased spatiotemporal gait variability (p = 0.010). Walking speed was moderately reduced (p = 0.026) with shortened stride length (p = 0.001) and increased periods of double support (p = 0.001). Gait dysfunction became more pronounced during slow walking (p < 0.001); this was not present during fast walking. Walking with eyes closed aggravated gait disability as did walking during cognitive dual task (p < 0.001). Conclusion OT is associated with a specific gait disorder with a staggering wide-based walking pattern indicative of a sensory and/or a cerebellar ataxic gait. The aggravation of gait instability during visual withdrawal and the normalization of walking with faster speeds further suggest a proprioceptive or vestibulo-cerebellar deficit as the primary source of gait disturbance in OT. In addition, the gait decline during cognitive dual task may imply cognitive processing deficits. In the end, OT is presumably a complex network disorder resulting in a specific spino-cerebello-frontocortical gait disorder that goes beyond mere tremor networks.

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Section: Discussionsupporting

confidence: 89%

The gait disorder in primary orthostatic tremor

et al. 2020

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“…The high prevalence of abnormal tandem gait in our case series probably merely reflects the surge of tremor severity when performing this task (ie, at low speed with a lot of support time). This lack of specificity of several appendicular and axial tests might explain the high prevalence of ataxic features in previous reports 12–15 . On the one hand, ataxia has been reported to be present in up to 50% of control patients indicating the low specificity for cerebellar dysfunction 14 .…”

Section: Discussionmentioning

confidence: 93%

“…This lack of specificity of several appendicular and axial tests might explain the high prevalence of ataxic features in previous reports. 12 , 13 , 14 , 15 On the one hand, ataxia has been reported to be present in up to 50% of control patients indicating the low specificity for cerebellar dysfunction. 14 On the other hand, on certain used ataxia rating scales contamination by tremor is very likely (eg, oscillating movement during finger to nose or abnormal tandem gait in the BARS).…”

Section: Discussionmentioning

confidence: 99%

“…Whereas initial reports describe the absence of ataxia and bradykinesia in POT, several recent reports indicate the potential presence of cerebellar ataxia. 10 , 11 , 12 , 13 , 14 , 15 These mainly comprise of features of gait such as reduced step length and increased step width, but also a certain degree of appendicular ataxia has been suggested. These observations are contradicted by case series demonstrating only very rare occurrence of ataxia.…”

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confidence: 99%

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The Phenomenology of Primary Orthostatic Tremor

Swinnen

Waal

Buijink

et al. 2022

Movement Disord Clin Pract

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Background The presence and prevalence of several neurological signs in patients with primary orthostatic tremor have not been systematically studied. Objectives To assess the prevalence of clinical features of primary orthostatic tremor. Methods Video‐based assessment by four raters of standardized neurological examination of 11 patients with primary orthostatic tremor. Results On standing, bent knees (7/11), hem sign (6/10), and a broad base of support (6/11) were the three most prevalent signs. Examination of gait revealed abnormal tandem gait (9/11) and bent knees (6/11) as the most prevalent clinical signs. In the arms, none of the patients displayed bradykinesia, ataxia, or dystonia. In the legs, ataxia was absent in all patients and bradykinesia was present in only one patient. Conclusions Abnormal tandem gait, bent knees, hem sign, and broad base on standing are the most prevalent clinical signs in primary orthostatic tremor. We did not encounter clear extrapyramidal or unequivocal cerebellar signs.

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“…There is increasing evidence to support the role of cerebellar networks in the pathophysiology of POT. Clinical studies have reported features of dysmetria and gait ataxia [6]. Positron emission tomography (PET) imaging has shown increased activation of bilateral cerebellum related either to a mismatch between the peripheral afferent and the cerebellar efferent traffic or to a primary disorder of the cerebellum [7].…”

Section: Discussionmentioning

confidence: 99%