Postural orthostatic tremor (POT) is a potentially disabling condition of older adults with a tremor developing after the person stands up. This is distinct from essential tremor.


Synonym: shaky legs syndrome


Clinical features:

(1) The patient experiences shaking in the legs when standing.

(2) The patient experiences postural instability and unsteadiness.

(3) There is a variable tremor in the trunk associated with tremor of the paraspinal muscles.

(4) There is a variable tremor involving the upper extremities.

(5) Symptoms tend to get worse over time.

(6) The tremor quickly disappears on sitting or when leaning for support. It also diminishes if the person is able to walk.


Examination shows a fast tremor after standing in muscles of the lower extremities that is absent at other times.


EMG testing shows high-frequency burst firing in weight-bearing muscles, usually in the order of 13 to 16 Hz.


Therapy: Most patients improve with clonazepam or other benzodiazepine.


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