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Suggest treatment for primary orthostatic tremor

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Posted on Wed, 18 Jun 2014
Question: My husband is 75yrs old and has been diagnosed with Primary Orthostatic tremor which his last movement disorder specialist states is a severe tremor which occurs when he is standing. He is presently on Primidone which is not effective. He had been put on Clonazepam of which he had a severe psychotic episode from. Have any new treatments or medications been effective? XXXX
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Answered by Dr. Albana Sejdini (1 hour later)
Brief Answer:
Treatment suggestions: Primary Orthostatic Tremor.

Detailed Answer:
Hi,

I have gone through the medical history of your husband and feel sorry for the situation he is in.

Now, Primary Orthostatic tremor (POT) includes a group of movement disorders where a person does involuntary movements when standing. It is otherwise called "Idiopathic Orthostatic Tremor".

Usually, clonazepam and primidone are the drugs of choice for POT. However, in some cases, when this treatment fails, other drugs might be used:
- propanolol
- gabapentin
- pregabalin
- carbidopa/levodopa
- phenobarbital
- valproic acid

You can discuss with his neurologist for these other options too. However, I advise to take time when you introduce new drugs to him. In other words, wait for at least 3 months before changing treatment.

Other options include bilateral thalamic deep brain stimulation (DBS) surgery. However, it all will depend on your husband's response to treatment and evaluation of his health status.

Hope it was of help! Let me know if you need further clarifications!
Dr.Albana
Above answer was peer-reviewed by : Dr. Chakravarthy Mazumdar
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Answered by
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Dr. Albana Sejdini

General & Family Physician

Practicing since :2006

Answered : 7194 Questions

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Suggest treatment for primary orthostatic tremor

Brief Answer: Treatment suggestions: Primary Orthostatic Tremor. Detailed Answer: Hi, I have gone through the medical history of your husband and feel sorry for the situation he is in. Now, Primary Orthostatic tremor (POT) includes a group of movement disorders where a person does involuntary movements when standing. It is otherwise called "Idiopathic Orthostatic Tremor". Usually, clonazepam and primidone are the drugs of choice for POT. However, in some cases, when this treatment fails, other drugs might be used: - propanolol - gabapentin - pregabalin - carbidopa/levodopa - phenobarbital - valproic acid You can discuss with his neurologist for these other options too. However, I advise to take time when you introduce new drugs to him. In other words, wait for at least 3 months before changing treatment. Other options include bilateral thalamic deep brain stimulation (DBS) surgery. However, it all will depend on your husband's response to treatment and evaluation of his health status. Hope it was of help! Let me know if you need further clarifications! Dr.Albana