Orthostatic Tremor Rating Scale Project

Orthostatic Tremor Rating Scale Project

Dr. Peter Bain, faculty member of Imperial College of Medicine, requests help from orthostatic tremor (OT) patients worldwide in assessing the severity and effects of OT. Dr. Bain’s rationale is the OT scale could be used for measuring the efficacy of specific treatments, and/or testing for new medicines. This project is a great opportunity to help Dr. Bain in “constructing a scale” for a disabling tremor whose response to drug treatment is overall unsatisfactory.

OT is a tremor that shares some overlap with essential tremor (ET), sparking constant debates as to whether OT is a subtype of ET. The best way to describe OT is feeling unsteady when standing, but feeling relieved when sitting or walking. The frequency of OT tremor is 13-18Hz in comparison to the average 6-8Hz frequency of ET. OT is not necessarily confined to the lower limbs. OT can appear in the arms, and head and trunk tremors can affect a small percentage of OT patients. Professionals argue that the presence of the upper limb tremor in OT defines it as a variant of ET, but the difference in frequencies, the poor response to the first-line ET agent Propranolol, a higher mean age of onset (51.4), the predominance of more females, and a weak association with inheritance, suggest OT is a separate and unique tremor. Tremor Action Network has referred USA OT patients to Gloria with the OT Resource, and collaborates internationally with the National Tremor Foundation that has a UK POT Support Group. If you have been diagnosed with OT please consider becoming involved in the OT project by responding directly to Dr. Bain’s letter, either by email or written correspondence. Dr. Bain’s request for your participation is as follows:


I am currently trying to construct a scale for assessing the SEVERITY of orthostatic tremor (OT) and its EFFECTS on patients with OT. Consequently, I would greatly appreciate help from people who suffer from OT.


The reasons for constructing a clinical rating scale for OT are that the scale could be used to:

  1. Document the severity of OT and its effect on the person with OT at clinic appointments, so that the doctor and patient with OT can be confident that a specific treatment is helping.
  2. Measure the severity of OT and its effects on the patient, so that new medicines can be tested for OT and the effects measured and ideally compared with other medicines.

Assess the Natural Evolution of OT in Each Patient:

Can you help? If from your experience with orthostatic tremor you have noticed ways in which you can tell it has got worse or better, even temporarily, please would you email or send a letter to Dr Peter Bain explaining what you have noticed. This information would be invaluable for constructing an OT Clinical Rating Scale which we would then test for reliability and validity. Examples: For example, you may have noticed that:

  1. You cannot stand still for so long when your OT is severe.
  2. Your legs get cramp when standing.
  3. Your hands might shake as well.

PLEASE send in your suggestions as every piece of information is in valuable for creating an OT clinical Rating Scale. Please write to or Email Dr Peter Bain at: Dr Peter Bain Department of Neurology Charing Cross Hospital London W6 8RF Email: [email protected] Thank you for your help with this project. Yours faithfully, Dr Peter Bain MA MD FRCP Consultant Neurologist

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