Apartis E, Tison F, Arné P, Jedynak C P, Vidailhet M
Neurophysiologie, Centre Hospitalo Universitaire Saint-Antoine, Paris, France.
Mov Disord. 2001 Nov;16(6):1133-6. doi: 10.1002/mds.1218.
Leg tremor during standing is a rare feature in idiopathic Parkinson's disease (PD). Tremor during standing usually has a low frequency (range, 4-6 Hz), similar to PD rest tremor frequency, and is improved by levodopa. We describe three cases of fast orthostatic tremor (FoT) of legs and trunk mimicking primary orthostatic tremor (OT) in patients treated with levodopa for PD. Asymmetrical akinetorigid syndrome was accompanied by a rest tremor in two cases. We obtained electrophysiological parameters by electromyographic (EMG) polygraphic recording after 16 hours withdrawal of antiparkinsonian treatment and at the maximal effect of levodopa in order to investigate the effect of dopaminergic stimulation upon such cases of orthostatic tremor in PD. Electrophysiological parameters of orthostatic tremor, especially frequency (range 14-18 Hz), were similar to that seen in POT. Severity of tremor was independent of seriousness and duration of PD. Levodopa had no effect either on the handicap due to OT or on the amplitude and frequency of the EMG OT activity. In contrast, mild improvement of OT was obtained with benzodiazepines in two cases and parkinsonian syndrome was levodopa-sensitive. These findings suggest that FoT in PD would not be directly controlled by the dopaminergic system. However, increased rhythmicities in basal ganglia or in cerebello-thalamic loops at the rapid frequencies range seen in PD could favor the emergence of a primary orthostatic tremor-like tremor in PD patients.
站立时腿部震颤在特发性帕金森病（PD）中是一种罕见特征。站立时的震颤通常频率较低（范围为4 - 6 Hz），与PD静止性震颤频率相似，且左旋多巴可改善这种震颤。我们描述了3例在接受左旋多巴治疗的PD患者中出现的腿部和躯干快速直立性震颤（FoT），类似于原发性直立性震颤（OT）。2例患者伴有不对称性运动不能 - 强直综合征及静止性震颤。为了研究多巴胺能刺激对PD患者此类直立性震颤的影响，我们在停用抗帕金森病治疗16小时后以及左旋多巴达到最大效应时，通过肌电图（EMG）多导记录获得了电生理参数。直立性震颤的电生理参数，尤其是频率（范围为14 - 18 Hz），与原发性直立性震颤所见相似。震颤的严重程度与PD的严重程度和病程无关。左旋多巴对OT导致的功能障碍以及EMG中OT活动的幅度和频率均无影响。相比之下，2例患者使用苯二氮䓬类药物后OT有轻度改善，且帕金森综合征对左旋多巴敏感。这些发现表明，PD中的FoT不会直接受多巴胺能系统控制。然而，在PD中所见的快速频率范围内，基底神经节或小脑 - 丘脑环路中节律性增加可能有利于PD患者出现原发性直立性震颤样震颤。
