P31. Gait disturbance in patients with orthostatic tremor. Issue 8 (August 2018)

• Record Type: Journal Article
• Authors: Möhwald, K.; Wühr, M.; Feil, K.; Schenkel, F.; Schlick, C.; Jahn, K.; Dieterich, M.; Brandt, T.; Schniepp, R.
• Is Part Of: Clinical neurophysiology. Volume 129:Issue 8(2018:Aug.)
• Page Start: e79
• Page End: e80
• Publication Date: 2018-08
• Subjects: Neurophysiology -- Periodicals; Electroencephalography -- Periodicals; Electromyography -- Periodicals; Neurology -- Periodicals; 612.8
• DOI: 10.1016/j.clinph.2018.04.672
• Languages: English
• ISSNs: 1388-2457

Abstract

Abstract : Introduction: Orthostatic tremor (OT) is a rare disorder of unclear etiology characterized by a 13–18 Hz tremor of the legs while standing with resolving symptoms during sitting or walking. OT is associated with other movement disorders such as parkinsonism, essential tremor or cerebellar disorders. Although gait disturbances are frequently described in these diseases, there is no systemic analysis of the gait disorder linked to OT. Therefore, the aim of this study is to investigate the gait performance of patients with OT assessed by a standardized sensorimotor and cognitive walking paradigm. Methods: Patients with a diagnosis of primary OT were screened and included in this study after informed consent. Gait performance was investigated during 8 different walking conditions using a pressure-sensitive sensor carpet (GAITRite®). Patients walked at preferred, slow and maximum walking speeds (PS, SS, MS), during head reclination and eyes closed conditions (HR, EC) as well as calculatory, semantic and motoric dual task conditions (DTC, DTS, DTM). The gait performance of patients was compared to age-matched healthy subjects. Gait parameters were assessed by a multivariate analysis of variance. Results: Eighteen patients with a diagnosis of primary OT with a mean age of 70.4 ± 5.9 years were included in the study. In all walking conditions gait velocity ( p < 0.001 PS, MS, EC, DTC, DTM) and step length ( p < 0.001, expect DTS p < 0.05) were significantly decreased. Increased double support with reduced swing phases could be observed during SS and EC ( p < 0.001). The base of support (BOS) was increased during PS ( p < 0.05), SS ( p < 0.01) and EC ( p < 0.001). The coefficient of variation (CV) declined for BOS in SS ( p < 0.05), whereas CV increased for both, step length and stride time, during SS ( p < 0.05), DTC, DTS (both p < 0.01) and especially EC ( p < 0.001). Increased gait asymmetry was observed during EC ( p < 0.001). Discussion: Although OT symptoms diminish during walking, we identified constant impairments of locomotion control. The gait disturbance was characterized by an increased level of a cautious gait (slow, small-stepped, increased double support phases and BOS). Moreover, we identified disturbance of gait stability (increased CV) and interlimb coordination (left-right asymmetry). The specific alterations were found in conditions with increased sensory feedback control as well as attentional cognitive gait control. This implies an impaired integration of sensory feedback, possibly due to a dysfunction of midline cerebellar structures, as cerebellar dysfunction in OT was frequently described.