Orthostatic tremor: clinical and diagnostic aspects

The article addresses the issue of orthostatic tremor (OT), a rare but clinically significant movement disorder that substantially affects patients’ quality of life and often remains undiagnosed in the early stages. The paper summarizes current perspectives on the clinical, neurophysiological, and diagnostic features of OT, with particular emphasis on its characteristic high-frequency synchronous tremor of the lower limbs that occurs while standing and disappears during walking or sitting. Special attention is given to diagnostic challenges, the role of electroneuromyography as a key method for confirming the diagnosis, and issues of differential diagnosis with essential tremor, Parkinson’s disease, restless legs syndrome, cerebellar and psychogenic tremor, as well as metabolic and drug-induced causes of tremor. The article presents a clinical case of a 45-year-old female patient with typical manifestations of OT, in whom there was a prolonged delay in establishing the correct diagnosis. The results of clinical, laboratory, and instrumental examinations are described, including electroneuromyography and tremorography, which made it possible to confirm the presence of an isometric action tremor in the lower limb muscles. The presented case highlights the need to increase clinicians’ awareness of OT and emphasizes the importance of a comprehensive diagnostic approach for timely diagnosis and optimization of patient management.