ABSTRACT

CASE PRESENTATION A 74-year-old woman was referred for ‘difficulty standing’, which began insidiously 5 years previously and gradually progressed to the point of being unable to stand for more than ‘a few seconds.’ The patient had to sit in the shower, and lean against a wall while brushing her teeth to avoid unsteadiness. She was unable to wait in a line and described a feeling of ‘having to sit down’ while standing. The patient was unaware of tremor of the lower extremities while standing until the referring neurologist pointed it out to her. She developed anxiety about standing and walking. Having previously been diagnosed with primary orthostatic tremor, she had experienced either side-effects or limited benefit from brief trials of clonazepam, valproic acid, propranolol, levodopa, primidone, gabapentin, and levetiracetam.