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Parkinson's Disease – Wearing Off Management — SCE Neurology MCQ

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HardMovement DisordersParkinson's Disease – Wearing Off ManagementSCE Neurology

A patient reports severe unsteadiness only while standing still; walking, leaning and sitting rapidly relieve it. Examination shows only fine rippling of both quadriceps while upright. Which neurophysiological finding would confirm primary orthostatic tremor?

Educational content. Not a substitute for clinical judgement or local policy.

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Correct answer: C — Highly coherent 13–18 Hz bursts in bilateral leg muscles during standing

Explanation lettering: C = shown as A · A = shown as B · D = shown as C · B = shown as D

A is too slow, unilateral and recorded in the wrong state. B resembles an upper-limb action tremor rather than orthostatic tremor. C invokes cortical discharges and walking, whereas symptoms usually improve with walking. D is correct: classical orthostatic tremor is confirmed by surface EMG or accelerometry while standing, demonstrating highly coherent 13–18 Hz activity across leg muscles. E is more compatible with continuous muscle activity in peripheral nerve hyperexcitability or stiff-person spectrum disease.

Reference: Orthostatic tremor: https://pn.bmj.com/content/11/4/240