Proprioceptive muscle tendon stimulation reduces symptoms in primary orthostatic tremor

Original Communication
  • 33 Downloads

Abstract

Introduction

Primary orthostatic tremor (OT) is characterized by high-frequency lower limb muscle contractions and a disabling sense of unsteadiness while standing. To date, therapeutic options for OT are limited. Here, we examined the effects of proprioceptive leg muscle stimulation via muscle tendon vibration (MTV) on tremor and balance control in patients with primary OT.

Methods

Tremor in nine patients with primary OT was examined during four conditions: standing (1), standing with MTV on the bilateral soleus muscles (2), lying (3), and lying with MTV (4). Tremor characteristics were assessed by frequency domain analysis of surface EMG recordings from four leg muscles. Body sway was analyzed using posturographic recordings.

Results

During standing, all patients showed a coherent high-frequency tremor in leg muscles and body sway that was absent during lying (p < 0.001). MTV during standing did not reset tremor frequency, but resulted in a decreased tremor intensity (p < 0.001; mean reduction: 32.5 ± 7.1%) and body sway (p = 0.032; mean reduction: 37.2 ± 6.8%). MTV did not affect muscle activity during lying. Four patients further reported a noticeable relief from unsteadiness during stimulation.

Conclusion

Proprioceptive stimulation did not reset tremor frequency consistent with the presumed central origin of OT. However, continuous MTV influenced the emergence of OT symptoms resulting in reduced tremor intensity, improved posture, and a relief from unsteadiness in half of the examined patients. These findings indicate that MTV either directly interferes with the peripheral manifestation of the central oscillatory pattern or prevents proprioceptive afferent feedback from becoming extensively synchronized at the tremor frequency.

Keywords

Orthostatic tremor Muscle tendon vibration Proprioception Tremor Body sway Unsteadiness 

Notes

Author contributions

Conceived and designed the study: MW, CS, and RS. Performed the study: MW, CS, KM, and RS. Performed statistical analysis: MW. Wrote the paper: MW. Critical revision of the manuscript: CS, KM, and RS.

Funding

This work was supported by the German Federal Ministry of Education and Research (01EO1401).

Compliance with ethical standards

Conflicts of interest

The authors declare that they have no competing interests.

Ethical standard

All experimental procedures were approved by the appropriate Ethics Committee.

References

  1. 1.
    Britton TC, Thompson PD, van der Kamp W, Rothwell JC, Day BL, Findley LJ, Marsden CD (1992) Primary orthostatic tremor: further observations in six cases. J Neurol 239(4):209–217CrossRefPubMedGoogle Scholar
  2. 2.
    Schöberl F, Feil K, Xiong G, Bartenstein P, la Fougere C, Jahn K, Brandt T, Strupp M, Dieterich M, Zwergal A (2017) Pathological ponto-cerebello-thalamo-cortical activations in primary orthostatic tremor during lying and stance. Brain 140(Pt 1):83–97CrossRefPubMedGoogle Scholar
  3. 3.
    Muthuraman M, Hellriegel H, Paschen S, Hofschulte F, Reese R, Volkmann J, Witt K, Deuschl G, Raethjen J (2013) The central oscillatory network of orthostatic tremor. Mov Disord 28(10):1424–1430CrossRefPubMedGoogle Scholar
  4. 4.
    Fung V, Sauner D, Day B (2001) A dissociation between subjective and objective unsteadiness in primary orthostatic tremor. Brain 124(2):322–330CrossRefPubMedGoogle Scholar
  5. 5.
    Valkovic P, Krafczyk S, Bötzel K (2006) Postural reactions to soleus muscle vibration in Parkinson’s disease: scaling deteriorates as disease progresses. Neurosci Lett 401(1–2):92–96Google Scholar
  6. 6.
    Farmer S, Bremner F, Halliday D, Rosenberg J, Stephens J (1993) The frequency content of common synaptic inputs to motoneurones studied during voluntary isometric contraction in man. J Physiol 470:127CrossRefPubMedPubMedCentralGoogle Scholar
  7. 7.
    Eklund G (1972) General features of vibration-induced effects on balance. Upsala J Med Sci 77(2):112–124CrossRefPubMedGoogle Scholar
  8. 8.
    Wu YR, Ashby P, Lang AE (2001) Orthostatic tremor arises from an oscillator in the posterior fossa. Mov Disord 16(2):272–279CrossRefPubMedGoogle Scholar
  9. 9.
    Hay L, Bard C, Fleury M, Teasdale N (1996) Availability of visual and proprioceptive afferent messages and postural control in elderly adults. Exp Brain Res 108(1):129–139CrossRefPubMedGoogle Scholar
  10. 10.
    Fallon JB, Macefield VG (2007) Vibration sensitivity of human muscle spindles and Golgi tendon organs. Muscle Nerve 36(1):21–29CrossRefPubMedGoogle Scholar
  11. 11.
    Feil K, Bottcher N, Guri F, Krafczyk S, Schoberl F, Zwergal A, Strupp M (2015) Long-term course of orthostatic tremor in serial posturographic measurement. Parkinsonism Relat Disord 21(8):905–910CrossRefPubMedGoogle Scholar
  12. 12.
    Ganos C, Maugest L, Apartis E, Gasca-Salas C, Caceres-Redondo MT, Erro R, Navalpotro-Gomez I, Batla A, Antelmi E, Degos B, Roze E, Welter ML, Mestre T, Palomar FJ, Isayama R, Chen R, Cordivari C, Mir P, Lang AE, Fox SH, Bhatia KP, Vidailhet M (2016) The long-term outcome of orthostatic tremor. J Neurol Neurosurg Psychiatry 87(2):167–172Google Scholar
  13. 13.
    Espay AJ, Duker AP, Chen R, Okun MS, Barrett ET, Devoto J, Zeilman P, Gartner M, Burton N, Miranda HA, Mandybur GT, Zesiewicz TA, Foote KD, Revilla FJ (2008) Deep brain stimulation of the ventral intermediate nucleus of the thalamus in medically refractory orthostatic tremor: preliminary observations. Mov Disord 23(16):2357–2362CrossRefPubMedGoogle Scholar
  14. 14.
    Chiang H-L, Tai Y-C, McMaster J, Fung VS, Mahant N (2017) Primary orthostatic tremor: is deep brain stimulation better than spinal cord stimulation? J Neurol Neurosurg Psychiatry 88(9):804–805CrossRefPubMedGoogle Scholar
  15. 15.
    Krauss JK, Weigel R, Blahak C, Bazner H, Capelle HH, Grips E, Rittmann M, Wohrle JC (2006) Chronic spinal cord stimulation in medically intractable orthostatic tremor. J Neurol Neurosurg Psychiatry 77(9):1013–1016CrossRefPubMedPubMedCentralGoogle Scholar

Copyright information

© Springer-Verlag GmbH Germany, part of Springer Nature 2018

Authors and Affiliations

  1. 1.German Center for Vertigo and Balance Disorders, University HospitalLMU MunichMunichGermany
  2. 2.Department of Neurology, University HospitalLMU MunichMunichGermany

Personalised recommendations