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Hobey13

Orthostatic tremor/Parkinson's

8 posts in this topic

I have been dx with a unilateral orthostatic tremor of 9 hz; I also have bilateral postural tremor in my hands/arms. My mds said this type of orthostatic tremor could be a sign of Parkinson's since I also have mild plmd; I was examined for Parkinson's and showed no signs; I had a datscan that came back normal; is the 9 hz unilateral orthostatic tremor an indicator of potential pd? The orthostatic tremor is helped by alcohol and propranolol, and for now has been diagnosed as an essential tremor variant; Assuming the datscan is correct with normal dopamine levels how long could it potentially take to go from normal levels to abnormal?

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Most orthostatic tremors are 15-18 Hz, however there is a variant that can be slower and around 10Hz.

 

If DAT is normal I would relax as this is not PD, and try to address with medications. No one knows if this is a risk factor for PD as it is a rare tremor. Some people use clonazepam to treat. Some people also get upper extremity and gait issues with orthostatic tremor.

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Thank you for the response. One item I have had an issue with for the past month is excessive saliva i n my mouth during the day and some drooling at night; the onset of this was sudden; can that be a manifestation of the orthostatic tremor? Is that a typical early sign of pd without any other symptoms?

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This is not typical for orthostatic tremor. I would run that symptom by your doc. It is a symptom that occurs later in the course of PD.

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I did meet with my MDS regarding the excess saliva symptom and he thought we should take a wait and see approach with it. He said there could be alot of causes for the saliva; if it continued to be disruptive ultimately I could go to an ENT person. We went over the DAT scan and he said it was as normal as could be asked for with two good commas. I have taken propanolol for the orthostatic tremor and that has helped it. He thought it was unlikley the saliva was pd related given the normal DAT scan, and the absence of any other pd symptoms (no rigidity, no bradykinesia, no constipation, smell test good, etc). Does this approach make sense? I am just not sure what else can be done regarding the excess saliva?

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We have used botox as a treatment for excess saliva. Remember drying up too much can lead to cavities!

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Have you seen or heard of situations in PD with where excess saliva issues predated motor symptoms? Does it not happen in PD until the motor symptoms are present, because it is the actual motor symptoms that cause the excess saliva/drooling?

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Typically in my clinic it has occurred later and may have many causes including dehydration and decreased swallowing or movement of secretions in the mouth. Hope that helps.

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