Orthostatic Tremor

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Abstract
To the Editor. —A recent patient encounter made us realize that Parkinson's disease is part of the differential diagnosis of orthostatic tremor. A 65-year-old man consulted us for confirmation of a diagnosis of orthostatic tremor with symptoms present for 5 years. He brought with him a copy of Heilman's classic article1 on orthostatic tremor. Indeed, on examination, we observed the typical manifestation of orthostatic tremor, ie, rapid, irregular, asynchronous tremor of the lower limbs and trunk coming on while the patient was standing. As did Heilman, we noted essential tremor of the upper limbs. However, the patient also had typical manifestations of Parkinson's disease that Heilman had carefully excluded in his patients—bradykinetic gait with festination, rigidity, seborrhea, virtually absent arm swing, and no rest tremor. We had the impression that the orthostatic tremor came on primarily when the patient became akinetic from his Parkinson's disease. Five weeks after starting

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