Temblor ortostático como causa de inestabilidad

Abstract

PALABRAS CLAVE Inestabilidad; Electromiografía; Temblor ortostáticoResumen El temblor ortostático (TO) es una enfermedad neurológica de origen desconocido caracterizada por un temblor de 10-20 Hz en las piernas en bipedestación. Se manifiesta por mareo e inestabilidad, que típicamente mejoran al apoyarse o sentarse y la ingesta de pequeñas cantidades de alcohol lo reduce de manera significativa. Se muestran 4 casos clí-nicos atendidos en nuestra consulta cuyo diagnóstico sugiere ser el de TO. Consideramos que ante un paciente con inestabilidad, es preciso plantearse como diagnóstico diferencial un TO. La historia clínica nos orienta hacia esta entidad y en caso de sospecha, el diagnóstico definitivo viene dado por el registro de la electromiografía en las extremidades inferiores en condición de reposo sentado y en ortostatismo donde se registra un temblor de 10-20 Hz. El tratamiento es médico y, se emplea el clonazepam como primera opción terapéu-tica. © 2011 Elsevier España, S.L. Todos los derechos reservados. KEYWORDS Instability; Electromyography; Orthostatic tremor Orthostatic tremor inducing instabilityAbstract Orthostatic tremor (OT) is a neurological disease of unknown aetiology. It is defined by the presence of a 10-20 Hz tremor in the legs while standing still. Symptoms described are dizziness and instability that diminish if the patient sits down or leans on something; drinking small amounts of alcohol significantly reduces OT. Due to the dizziness and/or unsteadiness, these patients are usually referred to the neuro-otology department. We report 4 cases diagnosed with OT. The diagnosis of OT should be considered for patients with instability. The clinical history is a key factor to suspect this entity, and the diagnosis is given by the register of 10-20 Hz contractions on limb electromyography. Treatment for this disease consists of medical treatment; the first option is clonazepam.

Slow Orthostatic Tremor: Review of the Current Evidence

“…There were a number of other slow OT cases identified within mixed case series of classical and slow OT, but lacked sufficient individual details to tabulate. 9,22–25…”

“…A shared underpinning for slow OT is suggested in patients with coexistent neurologic disorders manifesting with tremor of similar frequency as slow OT. A similar rationale can be made for structural lesions 13,25,26 or autoimmune disorders 13,29,33 that appear to be timelocked to the onset or offset of slow OT. This is aptly illustrated by the two patients with Graves’ disease, both with 8 Hz tremor, with complete remission after treatment with methimazole, suggesting the slow OT mechanism was due to enhanced physiological tremor.…”

Slow Orthostatic Tremor: Review of the Current Evidence

“…A similar rationale can be made for structural lesions 13,25,26 or autoimmune disorders 13,29,33 that appear to be timelocked to the onset or offset of slow OT. This is aptly illustrated by the two patients with Graves’ disease, both with 8 Hz tremor, with complete remission after treatment with methimazole, suggesting the slow OT mechanism was due to enhanced physiological tremor.…”