What are the best treatments for Primary Orthostatic Tremor?

Best Treatments for Primary Orthostatic Tremor

Primary Orthostatic Tremor (POT) is a rare neurological disorder characterized by rapid muscle contractions in the legs that occur when standing. These tremors can cause significant discomfort and difficulty with balance, leading to impaired mobility and reduced quality of life for those affected. While there is no known cure for POT, several treatment options can help manage the symptoms and improve daily functioning.

1. Medications

Medications are often the first line of treatment for Primary Orthostatic Tremor. While no specific drug has been approved for POT, certain medications have shown promise in reducing tremor severity and improving symptoms:

• Clonazepam: This anti-anxiety medication has been found to be effective in reducing tremors associated with POT. It works by enhancing the activity of a neurotransmitter called gamma-aminobutyric acid (GABA) in the brain, which helps to calm overactive nerve signals.


• Gabapentin: Originally developed to treat epilepsy, Gabapentin has also been used off-label to manage POT symptoms. It can help reduce tremor intensity and improve overall motor control.


• Primidone: Primidone is an anticonvulsant medication that has been used to alleviate tremors in various movement disorders, including POT. It works by suppressing abnormal electrical activity in the brain, thereby reducing tremor severity.

2. Physical Therapy

Physical therapy plays a crucial role in managing Primary Orthostatic Tremor. A skilled physical therapist can design a personalized exercise program to improve balance, coordination, and muscle strength. Some beneficial techniques and exercises include:

• Weight shifting exercises: These exercises involve shifting body weight from one leg to another, which helps improve stability and control during standing.


• Balance training: Specific exercises that challenge balance, such as standing on one leg or using balance boards, can enhance postural stability and reduce tremor severity.


• Strength training: Strengthening exercises targeting the leg muscles can improve overall muscle control and reduce the impact of tremors on daily activities.

3. Assistive Devices

Assistive devices can significantly improve the quality of life for individuals with Primary Orthostatic Tremor. These devices aim to enhance stability, reduce falls, and increase mobility. Some commonly used assistive devices include:

• Walking aids: Canes, walkers, or trekking poles provide additional support and stability while walking, reducing the risk of falls.


• Orthotic devices: Ankle-foot orthoses (AFOs) or braces can help stabilize the lower limbs and improve balance during standing and walking.


• Custom footwear: Shoes with built-in shock absorption and stability features can help minimize the impact of tremors on gait and balance.

4. Deep Brain Stimulation (DBS)

In severe cases of Primary Orthostatic Tremor that do not respond to medication or other conservative treatments, Deep Brain Stimulation (DBS) may be considered. DBS involves surgically implanting electrodes into specific areas of the brain responsible for movement control. These electrodes deliver electrical impulses to modulate abnormal brain activity and reduce tremor severity. DBS is a complex procedure and should only be performed by experienced neurosurgeons.

5. Lifestyle Modifications

While not a direct treatment, certain lifestyle modifications can help individuals with Primary Orthostatic Tremor manage their symptoms more effectively:

• Avoiding triggers: Identifying and avoiding factors that worsen tremors, such as stress, caffeine, or certain medications, can help minimize symptom severity.


• Regular exercise: Engaging in regular physical activity, such as walking, swimming, or cycling, can improve overall muscle strength and control, potentially reducing tremor intensity.


• Stress management: Techniques like deep breathing, meditation, or yoga can help reduce stress levels, which may indirectly alleviate tremor symptoms.

It is important to note that the effectiveness of treatments may vary from person to person. Consulting with a healthcare professional, such as a neurologist or movement disorder specialist, is crucial to develop an individualized treatment plan tailored to the specific needs of each patient.