Functional and Organic Pseudo-Orthostatic Tremor: Clinical Features, Electrophysiology, and Treatment Outcomes in a Retrospective Cohort
- 1Hospital Rey Juan Carlos
Abstract
BackgroundPseudo-orthostatic tremor (psOT) is a rare form of tremor of the lower body, triggered by standing, at frequencies lower than 13 Hz. It is believed to be secondary to other neurological disorders in a large proportion of cases. Surface electromyography (sEMG) can identify its core characteristics and differentiate it from other similar disorders such as primary orthostatic tremor (POT) and orthostatic myoclonus (OM).
ObjectivesOur study aims to illustrate the clinical and neurophysiological features as well as the outcomes and final diagnoses of patients with psOT in a retrospective two-centre cohort.
MethodsWe retrospectively examined the available clinical and neurophysiological records of 35 consecutive patients with a diagnosis of psOT in the 2022-2026 period. Data on demographics, clinical characteristics, sEMG findings, pharmacological treatments, ancillary investigations and patient reported outcomes were collected.
Results35 patients with psOT were identified, of which 6 (17%) displayed features consistent with a functional neurological disorder (FND). Among the 29 patients with organic psOT, 21 (72.4%) fulfilled the diagnostic criteria for essential tremor (ET), while an identifiable neurological cause was established in four (13.8%). sEMG findings differed between functional and organic psOT, with the latter often displaying features consistent with weight-bearing hyperkinesias.
ConclusionsOur retrospective study suggests that psOT is most often associated with ET, while an identifiable neurological cause was found in a relatively small proportion of patients. We also describe functional psOT as a previously unrecognized clinical presentation of FND.
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BibTeX
@misc{querejetacoma2026functional,
title = {{Functional and Organic Pseudo-Orthostatic Tremor: Clinical Features, Electrophysiology, and Treatment Outcomes in a Retrospective Cohort}},
author = {A. Querejeta-Coma and L. M. Yupanqui-Guerra and L. Santos-Sanchez-de-las-Matas and A. Gomez-Dominguez and H. Canfield-Medina and R. Cano-de-la-Cuerda and C. M. Ordas-Bandera},
howpublished = {medRxiv},
year = {2026},
month = oct,
doi = {10.64898/2026.10.18.26365840},
url = {https://www.medrxiv.org/content/10.64898/2026.10.18.26365840v1},
note = {CC BY},
}
RIS
TY - UNPB
TI - Functional and Organic Pseudo-Orthostatic Tremor: Clinical Features, Electrophysiology, and Treatment Outcomes in a Retrospective Cohort
AU - A. Querejeta-Coma
AU - L. M. Yupanqui-Guerra
AU - L. Santos-Sanchez-de-las-Matas
AU - A. Gomez-Dominguez
AU - H. Canfield-Medina
AU - R. Cano-de-la-Cuerda
AU - C. M. Ordas-Bandera
PY - 2026
DA - 2026/10/18
PB - medRxiv
DO - 10.64898/2026.10.18.26365840
UR - https://www.medrxiv.org/content/10.64898/2026.10.18.26365840v1
AB - BackgroundPseudo-orthostatic tremor (psOT) is a rare form of tremor of the lower body, triggered by standing, at frequencies lower than 13 Hz. It is believed to be secondary to other neurological disorders in a large proportion of cases. Surface electromyography (sEMG) can identify its core characteristics and differentiate it from other similar disorders such as primary orthostatic tremor (POT) and orthostatic myoclonus (OM). ObjectivesOur study aims to illustrate the clinical and neurophysiological features as well as the outcomes and final diagnoses of patients with psOT in a retrospective two-centre cohort. MethodsWe retrospectively examined the available clinical and neurophysiological records of 35 consecutive patients with a diagnosis of psOT in the 2022-2026 period. Data on demographics, clinical characteristics, sEMG findings, pharmacological treatments, ancillary investigations and patient reported outcomes were collected. Results35 patients with psOT were identified, of which 6 (17%) displayed features consistent with a functional neurological disorder (FND). Among the 29 patients with organic psOT, 21 (72.4%) fulfilled the diagnostic criteria for essential tremor (ET), while an identifiable neurological cause was established in four (13.8%). sEMG findings differed between functional and organic psOT, with the latter often displaying features consistent with weight-bearing hyperkinesias. ConclusionsOur retrospective study suggests that psOT is most often associated with ET, while an identifiable neurological cause was found in a relatively small proportion of patients. We also describe functional psOT as a previously unrecognized clinical presentation of FND.
ER -