Levodopa may improve orthostatic tremor: case report and trial of treatment

Primary orthostatic tremor is a regular fast lower limb tremor causing unst eadiness on standing. Treatment is generally unsatisfactory. A patient with primary orthostatic tremor who 9 years later developed levodopa responsive idiopathic Parkinson's disease is described. The patient exhibited the cla ssic features of primary orthostatic tremor with relief of the tremor by wa lking or sitting while treated with levodopa. However, in the "off" state, when the benefits of levodopa disappeared, this orthostatic tremor was cont inuous and severely compromised the patient's gait. On the basis of this fi nding eight patients with primary orthostatic tremor were treated with levo dopa. Five patients experienced benefit and elected to remain on long term treatment. This study is the first trial of therapy in primary orthostatic tremor and suggests that levodopa can lead to good symptomatic relief in th is potentially disabling condition.