Journal of Movement Disorders

Original Article

Analysis of Semiology, Lesion Topography and Treatment Outcomes: A Prospective Study on Post Thalamic Stroke Holmes Tremor: Amlan Kusum Datta, Adreesh Mukherjee, Sudeshna Malakar, Atanu Biswas; J Mov Disord. 2024;17(1):71-81. Published online October 20, 2023; DOI: https://doi.org/10.14802/jmd.23095

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Abstract PDF Supplementary Material: Objective
Holmes tremor (HT) comprises rest, postural and intention tremor subtypes, usually involving both proximal and distal musculature. Perturbations of nigro-striatal pathways might be fundamental in the pathogenesis of HT along with cerebello-thalamic connections.
Methods
Nine patients with an HT phenotype secondary to thalamic stroke were included. Epidemiological and clinical records were obtained. Structural and functional brain imaging were performed with magnetic resonance imaging (MRI) or computed tomography (CT) and positron emission tomography (PET), respectively. Levodopa was administered in sequentially increasing dosage, with various other drugs in case of inadequate response. Longitudinal follow-up was performed for at least three months. The essential tremor rating assessment scale (TETRAS) was used for assessment.
Results
The mean latency from stroke to tremor onset was 50.4 ± 30.60 days (range 21–90 days). Dystonia was the most frequently associated hyperkinetic movement (88.8%). Tremor was bilateral in 22.2% of participants. Clinical response was judged based on a reduction in the TETRAS score by a prefixed value (≥ 30%), pertaining to which 55.5% (n = 5) of subjects were classified as responders and the rest as non-responders. The responders showed improvement with significantly lower doses of levodopa than the remaining nonresponders (240 ± 54.7 mg vs. 400 ± 40.8 mg; p = 0.012).
Conclusion
Although levodopa is useful in HT, augmenting the dosage of levodopa beyond a certain point might not benefit patients clinically. Topography of vascular lesions within the thalamus might additionally influence the phenomenology of HT.

Review Articles

Adult-Onset Genetic Leukoencephalopathies With Movement Disorders: Mu-Hui Fu, Yung-Yee Chang; J Mov Disord. 2023;16(2):115-132. Published online March 7, 2023; DOI: https://doi.org/10.14802/jmd.22127

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Abstract PDF: Genetic leukoencephalopathies (GLEs) are a group of white matter abnormalities with heterogeneous radiological and phenotypic features. Although these conditions have mostly been described in children, adult-onset cases are increasingly recognized owing to the widespread use of neuroimaging and advances in molecular genetic testing. The disease course is often progressive with a varied spectrum of presentations, trapping neurologists in the dilemma of differential diagnosis. Movement disorders are among the most common symptoms, and their diversity makes diagnosis challenging. In this review, we focus on adult-onset GLEs with movement disorders and offer a step-by-step diagnostic approach by clarifying the phenomenology of movement, advising investigations for acquired causes, describing the clinical and radiological clues to each disease, emphasizing the limitations of advanced molecular testing, and discussing the future application of artificial intelligence. We provide a list summarizing the leukoencephalopathies associated with different categories of movement disorders. In addition to guiding clinicians on how to narrow the list of differential diagnoses with the tools currently available, another aim of this review is to emphasize the inevitable trend toward applying advanced technology in diagnosing these difficult diseases.

Movement Disorders Associated With Radiotherapy and Surgical Procedures: Bharath Kumar Surisetti, Shweta Prasad, Vikram Venkappayya Holla, Nitish Kamble, Ravi Yadav, Pramod Kumar Pal; J Mov Disord. 2023;16(1):42-51. Published online January 12, 2023; DOI: https://doi.org/10.14802/jmd.22092

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Abstract PDF

Occasionally, movement disorders can occur following interventional procedures including but not limited to radiotherapy, dental procedures, and cardiac, cerebral and spinal surgeries. The majority of these disorders tend to be unexpected sequelae with variable phenomenology and latency, and they can often be far more disabling than the primary disease for which the procedure was performed. Owing to poor knowledge and awareness of the problem, delays in diagnosing the condition are common, as are misdiagnoses as functional movement disorders. This narrative review discusses the phenomenology, pathophysiology, and potential treatments of various movement disorders caused by interventional procedures such as radiotherapy and neurological and non-neurological surgeries and procedures.

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Biofeedback Endurance Training for Gait Rehabilitation in Parkinson’s Disease: a Non-Randomized Controlled Study
Olga V. Guseva, Natalia G. Zhukova
Bulletin of Rehabilitation Medicine.2024; 22(6): 21. CrossRef

Case Report

Deep Brain Stimulation for Cockayne Syndrome-Associated Movement Disorder: Joseph S. Domino, Rose Gelineau-Morel, Christian Kaufman; J Mov Disord. 2022;15(1):62-65. Published online November 3, 2021; DOI: https://doi.org/10.14802/jmd.21005

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Abstract PDF Supplementary Material

Cockayne syndrome (CS) is a rare progeroid disorder characterized by multisystem degeneration, including neurological dysfunction, for which deep brain stimulation (DBS) is a proposed treatment. This study represents only the third case of DBS for CS-associated movement disorder and the first in which both proposed targets had devices implanted, allowing for direct comparison. A case of DBS for CS-associated movement disorder is presented. Previous literature documents two cases with one targeting the ventral intermediate nucleus of the thalamus (VIM) and the other targeting the globus pallidus interna (GPi). Our patient underwent stimulation of GPi nuclei followed by repositioning to VIM nuclei with improved symptom control using VIM stimulation. In all cases, there was a significant clinical benefit without off-target effects. CS-associated movement disorder exhibits phenotypic variability for which DBS is a viable treatment. Target selection should be driven by clinical phenotype.

Citations

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Cockayne syndrome type 3 with dystonia‐ataxia and clicking blinks
Özge Berna Gültekin‐Zaim, Gül Yalçın‐Çakmaklı, Ayşe İlksen Çolpak, Pelin Özlem Şimşek‐Kiper, Gülen Eda Utine, Bülent Elibol
Movement Disorders Clinical Practice.2023;[Epub] CrossRef

Brief communication

Phonatory Characteristics of Male Patients with Classic Essential Tremor: Preetie Shetty Akkunje, Belur Keshavaprasad Yamini, Ravi Yadav, Nagarajarao Shivashankar, Palash Kumar Malo, Kandavel Thennarasu, Shantala Hegde, Pramod Kumar Pal; J Mov Disord. 2021;14(3):226-230. Published online August 18, 2021; DOI: https://doi.org/10.14802/jmd.21010

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Abstract PDF Supplementary Material

Objective
Voice tremor (VT) is one of the characteristics of essential tremor (ET). This study was designed to describe the group and phonatory characteristics of classic ET patients with VT.
Methods
This retrospective case-control study compared classic ET patients with age and sex-matched controls. The ET population was subgrouped based on auditory perceptual voice analysis. Electroglottography and acoustic voice samples obtained from both groups were analyzed for contact quotient (CQ) and multidimensional voice program parameters, i.e., fundamental frequency (F₀), perturbation, noise, and tremor parameters.
Results
The CQ, F₀, perturbation, noise, and tremor characteristics significantly increased from the moderate VT group to the severe VT group.
Conclusion
The CQ, F₀, and noise characteristics reflected the vocal folds’ functionality. The perturbation and tremor parameters variation were reasoned considering the tremor-related changes occurring in the laryngeal, vocal tract, and expiratory muscles in patients with ET. Thus, phonatory analysis may help in monitoring the progression of ET.

Citations

Citations to this article as recorded by

Voice Analysis in Patients with Essential Tremor
Hakan Silek, Muzeyyen Dogan
Journal of Voice.2023;[Epub] CrossRef

Case Report

Involuntary Movements Following Administration of Hydroxychloroquine for COVID-19 Pneumonia: Emmaline Zantua Fernando, Jeryl Ritzi Tan Yu, Salvador Miclat Abad Santos, Roland Dominic Go Jamora; J Mov Disord. 2021;14(1):75-77. Published online December 7, 2020; DOI: https://doi.org/10.14802/jmd.20091

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Abstract PDF Supplementary Material

Hydroxychloroquine (HCQ) has been used as an investigational drug for patients with moderate to severe coronavirus disease 2019 (COVID-19). There have been concerns of potential harms from side effects of the drug. We present a case of a 38-year-old male who was started on HCQ for COVID-19 pneumonia. He was referred for evaluation of myoclonus of all extremities, which resolved after discontinuation of HCQ. The involuntary movements were first reported after the initiation of HCQ, persisted despite improvement in inflammatory and radiologic parameters and eventually resolved after HCQ discontinuation. This supports a possible causality related to adverse drug reactions from HCQ that have not been commonly reported.

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Safety profile of COVID-19 drugs in a real clinical setting
Mei Nee Chiu, Maitry Bhardwaj, Sangeeta Pilkhwal Sah
European Journal of Clinical Pharmacology.2022; 78(5): 733. CrossRef
Eventos adversos no sistema nervoso central potencialmente relacionados aos medicamentos utilizados na COVID-19: revisão de escopo
Vinícius de Mello, Vinícius de Paula Pereira, João Paulo Vilela Rodrigues, Suelem Tavares da Silva Penteado, Leonardo Régis Leira Pereira, Fabiana Rossi Varallo
Revista Panamericana de Salud Pública.2022; 46: 1. CrossRef

Review Article

Principles of Electrophysiological Assessments for Movement Disorders: Kai-Hsiang Stanley Chen, Robert Chen; J Mov Disord. 2020;13(1):27-38. Published online January 31, 2020; DOI: https://doi.org/10.14802/jmd.19064

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Abstract PDF Supplementary Material

Electrophysiological studies can provide objective and quantifiable assessments of movement disorders. They are useful in the diagnosis of hyperkinetic movement disorders, particularly tremors and myoclonus. The most commonly used measures are surface electromyography (sEMG), electroencephalography (EEG) and accelerometry. Frequency and coherence analyses of sEMG signals may reveal the nature of tremors and the source of the tremors. The effects of voluntary tapping, ballistic movements and weighting of the limbs can help to distinguish between organic and functional tremors. The presence of Bereitschafts-potentials and beta-band desynchronization recorded by EEG before movement onset provide strong evidence for functional movement disorders. EMG burst durations, distributions and muscle recruitment orders may identify and classify myoclonus to cortical, subcortical or spinal origins and help in the diagnosis of functional myoclonus. Organic and functional cervical dystonia can potentially be distinguished by EMG power spectral analysis. Several reflex circuits, such as the long latency reflex, blink reflex and startle reflex, can be elicited with different types of external stimuli and are useful in the assessment of myoclonus, excessive startle and stiff person syndrome. However, limitations of the tests should be recognized, and the results should be interpreted together with clinical observations.

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Myoclonus and other jerky movement disorders
Sterre van der Veen, John N. Caviness, Yasmine E.M. Dreissen, Christos Ganos, Abubaker Ibrahim, Johannes H.T.M. Koelman, Ambra Stefani, Marina A.J. Tijssen
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Posthypoxic Segmental Spinal “Flutter”-Like Myoclonus
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Case Report

Treatment of Hemichoreoathetosis with Arrhythmic Proximal Tremor after Stroke: The Role of Zona Incerta as a Target for Deep Brain Stimulation: Andrei Koerbel, Augusto Radünz do Amaral, Helena Bedatti Zeh, Eduardo Wollmann, Renata Fabiola Heil Koerbel, Carla Moro, Alexandre Luiz Longo; J Mov Disord. 2019;12(1):47-51. Published online January 30, 2019; DOI: https://doi.org/10.14802/jmd.18032

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Abstract PDF Supplementary Material

Deep brain stimulation (DBS) of the zona incerta has shown promising results in the reduction of medically refractory movement disorders. However, evidence supporting its efficacy in movement disorders secondary to hemorrhagic stroke or hemichoreoathetosis is limited. We describe a 48-year-old man who developed progressive hemichoreoathetosis with an arrhythmic, proximal tremor in his right arm following a thalamic hemorrhagic stroke. Pharmacological treatment was carried out with no change in the Abnormal Involuntary Movement Scale (AIMS) score after 4 weeks (14). After six sessions of botulinum toxin treatment, a subtle improvement in the AIMS score (13) was registered, but no clinical improvement was noted. The arrhythmic proximal movements were significantly improved after DBS of the zona incerta with a major decrease in the patient’s AIMS score (8). The response to DBS occurring after the failure of pharmacological and botulinum toxin treatments suggests that zona incerta DBS may be an alternative for postthalamic hemorrhage movement disorders.

Citations

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Deep brain stimulation for movement disorders after stroke: a systematic review of the literature
Mitch R. Paro, Michal Dyrda, Srinath Ramanan, Grant Wadman, Stacey-Ann Burke, Isabella Cipollone, Cory Bosworth, Sarah Zurek, Patrick B. Senatus
Journal of Neurosurgery.2022; : 1. CrossRef
Deep brain stimulation for post-thalamic stroke complex movement disorders
A. Macerollo, B. Hammersley, M. Bonello, J. Somerset, D. Bhargava, K. Das, J. Osman-Farah, P. R. Eldridge, S. H. Alusi
Neurological Sciences.2021; 42(1): 337. CrossRef
Neurologic Manifestations of Systemic Disease: Movement Disorders
Giulietta M. Riboldi, Steven J. Frucht
Current Treatment Options in Neurology.2021;[Epub] CrossRef

Original Article

Clinical Characteristics of Involuntary Movement in Hospitalized Patients: Kyum-Yil Kwon, Hye Mi Lee, Seon-Min Lee, Seong-Beom Koh; J Mov Disord. 2019;12(1):31-36. Published online December 20, 2018; DOI: https://doi.org/10.14802/jmd.18040

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Abstract PDF

Objective
Neurological symptoms in hospitalized patients are not rare, and neurological consultation for movement disorders is especially important in evaluating or managing those with various movement disorders. Therefore, we investigated a clinical pattern of in-hospital consultations for various movement disorders in a tertiary care university hospital.
Methods
Over two years, a total of 202 patients (70.7 ± 11.8 years of age) presenting with movement disorders referred to movement disorder specialists were investigated.
Results
The main symptoms referred by nonneurologists were tremor (56.9%), parkinsonism (16.8%), and gait disturbance (8.9%). The most frequent diagnostic category was toxic/metabolic-caused movement disorder (T/MCMD) (35%) with regard to medications, followed by Parkinson’s disease (PD) (16%). Regarding the mode of onset, T/MCMD was the leading cause for acute (68%) and subacute onset (46%), while PD was the leading disorder (31%) for chronic onset.
Conclusion
The current study showed a characteristic pattern of inpatients presenting with movement disorders. Furthermore, our findings highlighted the clinical significance of drug use or metabolic problems for treating this patient population.

Citations

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Pattern and frequency of involuntary movements: hospital-based study
H. N. El Tallawy, A. S. Shalash, M. A. Abdelhamed, R. E. Elsabrout
The Egyptian Journal of Neurology, Psychiatry and Neurosurgery.2023;[Epub] CrossRef
Clinical Spectrum of Movement Disorders in Neurology Inpatients in a Tertiary Care Centre
Shabeer Ahmad Paul, Gouranga Prasad Mondal, Ramesh Bhattacharyya, Kartik Chandra Ghosh, Sarbajit Das, Suman Das, Hema Krishna, Chandrakanta Patra
Journal of Neurosciences in Rural Practice.2021; 12: 581. CrossRef

Case Report

Holmes’ Tremor with Shoulder Pain Treated by Deep Brain Stimulation of Unilateral Ventral Intermediate Thalamic Nucleus and Globus Pallidus Internus: Sabri Aydın, Huseyin Canaz, Ezgi Tuna Erdogan, Nazlı Durmaz, Barıs Topcular; J Mov Disord. 2017;10(2):92-95. Published online April 18, 2017; DOI: https://doi.org/10.14802/jmd.16051

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Abstract PDF

A 21-year-old male was admitted with severe right arm and hand tremors after a thalamic hemorrhage caused by a traffic accident. He was also suffering from agonizing pain in his right shoulder that manifested after the tremor. Neurologic examination revealed a disabling, severe, and irregular kinetic and postural tremor in the right arm during target-directed movements. There was also an irregular ipsilateral rest tremor and dystonic movements in the distal part of the right arm. The amplitude was moderate at rest and extremely high during kinetic and intentional movements. The patient underwent left globus pallidum internus and ventral intermediate thalamic nucleus deep brain stimulation. The patient improved by more than 80% as rated by the Fahn-Tolosa-Marin Tremor Rating Scale and Visual Analog Scale six months after surgery.

Citations

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Holmes tremor: an updated review
Efstratios-Stylianos Pyrgelis, Eleni Agapiou, Efthalia Angelopoulou
Neurological Sciences.2022; 43(12): 6731. CrossRef
Deep brain stimulation of the posterior subthalamic area as an alternative strategy for management of Holmes tremor: A case report and review of the literature
Omid Yousefi, Mojtaba Dayyani, Razieh Rezaei, Hooman Kamran, Ali Razmkon
Surgical Neurology International.2022; 13: 489. CrossRef
Vim stereotactic radiosurgical thalamotomy for drug-resistant idiopathic Holmes tremor: a case report
Manjul Tripathi, Sahil Mehta, Raghav Singla, Chirag K. Ahuja, Naresh Tandalya, Constantin Tuleasca, Aman Batish, Sandeep Mohindra, Abhinav Agrahari, Rupinder Kaur
Acta Neurochirurgica.2021; 163(7): 1867. CrossRef
Deep brain stimulation in uncommon tremor disorders: indications, targets, and programming
Carlo Alberto Artusi, Ashar Farooqi, Alberto Romagnolo, Luca Marsili, Roberta Balestrino, Leonard L. Sokol, Lily L. Wang, Maurizio Zibetti, Andrew P. Duker, George T. Mandybur, Leonardo Lopiano, Aristide Merola
Journal of Neurology.2018; 265(11): 2473. CrossRef

Original Articles

Movement Disorders in Non-Wilsonian Hepatic Cirrhotic Patients: The Subgroup Analysis of Various Phenotypes and Associated Risk Factors: Kulthida Methawasin, Piyanant Chonmaitree, Chatchawan Wongjitrat, Suthee Rattanamongkolgul, Thanin Asawavichienjinda; J Mov Disord. 2016;9(2):104-113. Published online March 28, 2016; DOI: https://doi.org/10.14802/jmd.15047

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Abstract PDF: Objective
The aim of this subgroup analysis was to identify the risk factors associated with the development of various movement disorder phenotypes.
Methods
Eighty-three non-Wilsonian cirrhotic patients with abnormal movements were allocated into the following groups: intention tremor, bradykinesia, Parkinsonism, and abnormal ocular movements. These movement types were considered the primary outcomes as there was a sufficient sample size. Researchers took into consideration the gender, etiologies of cirrhosis, cirrhosis-related complications, hepatic encephalopathy, medical illness, and some neurological deficits as potential factors associated with these movement disorders.
Results
The male gender (p = 0.002) and alcoholic cirrhosis (p = 0.005) were significant factors for the prevalence of intention tremors. In bradykinesia, hepatic encephalopathy was highly statistically significant (p < 0.001), and females more commonly developed bradykinesia (p = 0.04). The Parkinsonism features in this study were confounded by hyperlipidemia (p = 0.04) and motor or sensory deficits (p = 0.02). Jerky pursuits and a horizontal nystagmus were detected. Jerky pursuits were significantly related to hepatic encephalopathy (p = 0.003) and bradykinesia, but there were no factors associated with the prevalence of nystagmus other than an intention tremor.
Conclusions
The association of alcoholic cirrhosis with the development of intention tremor indicates that the persistent cerebellar malfunction in cirrhotic patients is due to alcohol toxicity. The slowness of finger tapping and jerky pursuit eye movements are significantly associated with hepatic encephalopathy. Thus, further studies are needed to evaluate the diagnostic value of these two signs for an early detection of mild hepatic encephalopathy.

Movement Disorders in Non-Wilsonian Cirrhotic Patients: A Report of the Prevalence and Risk Factors from a Study Done in a Medical School in an Agricultural-Based Community: Kulthida Methawasin, Piyanant Chonmaitree, Chatchawan Wongjitrat, Suthee Rattanamongkolgul, Thanin Asawavichienjinda; J Mov Disord. 2016;9(1):28-34. Published online December 3, 2015; DOI: https://doi.org/10.14802/jmd.15034

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Abstract PDF

Objective
Parkinsonism and other movement disorders have previously been reported in the acquired hepatocerebral degeneration associated with portosystemic shunting. However, there is no study to date about their prevalence as has been noted in general practice.
Methods
One hundred and forty-three patients with hepatic cirrhosis from the gastroenterology clinic and internal medicine wards were enrolled. Liver data included the diagnoses, etiologies, assessments of complications, and treatments for cirrhosis. Hepatic encephalopathy was classified with regard to the West Haven criteria for semi-quantitative grading for mental status. Neurological examination results and abnormal involuntary movements were recorded as primary outcomes. Neuro-radiology was used for the detection of severe brain lesions.
Results
Alcoholism was the most common cause of liver cirrhosis. Eighty-three patients (58%) presented with movement disorders. Asterixis was found in one of the cases. The most common movement disorder seen was an intentional tremor at 37.1%, which was followed by bradykinesia, Parkinsonism, and postural tremors at 29.4%, 10.5%, and 6.3%, respectively. The prevalence of movement disorders simultaneously increased with a high Child-Turcotte-Pugh score. The hepatic encephalopathy was grade 1 and 2. With the inclusion of age-range adjustments, we found that alcoholic cirrhosis and hepatic encephalopathy are statistically significant factors [p < 0.05, odds ratio (OR) = 6.41, 95% confidence interval (CI) 1.38–29.71 and p < 0.001, OR = 13.65, 95% CI 4.71–39.54] for the development of movement disorders in non-Wilsonian cirrhotic patients. Conclusions Intentional tremor is a common abnormal movement. Alcoholic cirrhosis and hepatic encephalopathy are significant risk factors in the development of movement disorders in non-Wilsonian cirrhotic patients.

Citations

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A Prospective Study of the Prevalence of Parkinsonism in Patients With Liver Cirrhosis
Diana Apetauerova, Peter Hildebrand, Stephanie Scala, Janet W. Zani, LeeAnne Lipert, Erin Clark, Tanya Fennell, Fredric D. Gordon
Hepatology Communications.2021; 5(2): 323. CrossRef

Case Reports

Giant Middle Fossa Epidermoid Presenting as Holmes’ Tremor Syndrome: Bindu Menon, P Sasikala, Amit Agrawal; J Mov Disord. 2014;7(1):22-24. Published online April 30, 2014; DOI: https://doi.org/10.14802/jmd.14005

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Abstract PDF

Intracranial dermoids may gradually reach an enormous size before the onset of symptoms. Common clinical presentations of intracranial epidermoid include headache and seizures. We present a case of a 35-year female patient with giant middle fossa epidermoid that presented with Holmes’ tremor syndrome, and we review the relevant literature. To the best of our knowledge, such a presentation has not previously been described in the literature.

Citations

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Holmes tremor
Gabriela B. Raina, Maria G. Cersosimo, Silvia S. Folgar, Juan C. Giugni, Cristian Calandra, Juan P. Paviolo, Veronica A. Tkachuk, Carlos Zuñiga Ramirez, Andrea L. Tschopp, Daniela S. Calvo, Luis A. Pellene, Marcela C. Uribe Roca, Miriam Velez, Rolando J.
Neurology.2016; 86(10): 931. CrossRef
Movement Disorders Following Cerebrovascular Lesions: Etiology, Treatment Options and Prognosis
Do-Young Kwon
Journal of Movement Disorders.2016; 9(2): 63. CrossRef

A Case of Intractable Psychogenic Essential Palatal Tremor: Eun Joo Chung, Hyun Jung, Sang Jin Kim; J Mov Disord. 2012;5(2):55-56.; DOI: https://doi.org/10.14802/jmd.12013

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Abstract PDF

Essential palatal tremor (EPT) is a rare disorder which shows rhythmic involuntary movement of the muscles of soft palate, especially tensor veli palatini muscle. EPT is classified by two subtypes, which is primary and secondary EPT. Secondary EPT includes psychogenic type. We describe a case of intractable psychogenic EPT.

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Botulinum toxin treatment for essential palatal tremors presenting with nasal clicks instead of pulsatile tinnitus: a case report
Yufeng Ye, Shiyu Liao, Baozhen Luo, Liyan Ni
Head & Face Medicine.2016;[Epub] CrossRef

Dopa Responsive Slow Orthostatic Tremor in Parkinson’s Disease: Suk Yoon Lee, Eun Joo Chung, Yeo Jung Kim, Sang Jin Kim; J Mov Disord. 2011;4(2):82-84.; DOI: https://doi.org/10.14802/jmd.11019

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86 Download
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Abstract PDF

Slow orthostatic tremor (OT) occurred to longer and lower frequency regular rhythmic bursts in leg muscle upon standing. The slow OT was often able to clinically confused with orthostatic myoclonus. We described a Parkinson’s disease patient with levodopa responsive slow OT. She showed abnormal movements of more regular rhythms and stable frequency on both legs on standing. These symptoms were aggravated at off state and improved by increasing levodopa.

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Orthostatic myoclonus – A retrospective study of Asian patients
Yi-Cheng Tai, Hung-Chang Kuo, Yihui Wu, Shih-Pin Hsu
Journal of the Formosan Medical Association.2022; 121(7): 1310. CrossRef
Therapeutic Devices for Motor Symptoms in Parkinson’s Disease: Current Progress and a Systematic Review of Recent Randomized Controlled Trials
Joji Fujikawa, Ryoma Morigaki, Nobuaki Yamamoto, Teruo Oda, Hiroshi Nakanishi, Yuishin Izumi, Yasushi Takagi
Frontiers in Aging Neuroscience.2022;[Epub] CrossRef
Unilateral Pseudo-Orthostatic Tremor Provoked by a Remote Limb Movement in Parkinson’s Disease
Sang-Won Yoo, Youngje Heo, Joong-Seok Kim, Kwang-Soo Lee
Journal of Movement Disorders.2020; 13(1): 69. CrossRef
Levodopa-Responsive Primary Slow Orthostatic Tremor: A Premotor Sign of Parkinson’s Disease?
Fumihito Yoshii, Wakoh Takahashi, Koji Aono
Case Reports in Neurology.2020; 12(1): 1. CrossRef

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