Systematic review of pharmacological treatment options for orthostatic tremor in prospective patient cohorts and randomized controlled trials

• Published in: Neurological sciences Vol. 46; no. 8; pp. 3419 - 3425
• Main Authors: Sauthoff, Lena, Achutegui, Maider Iza, Ye, Lan, Niesmann, Clara, Wegner, Florian, Höllerhage, Matthias, Klietz, Martin
• Format: Journal Article
• Language: English
• Published: Cham Springer International Publishing 01.08.2025; Springer Nature B.V
• Subjects: Anticonvulsants - therapeutic use; Botulinum toxin; Clinical trials; Dizziness - drug therapy; Drug dosages; Drug therapy; Etiracetam; Gabapentin; Gabapentin - therapeutic use; Humans; Levodopa; Medicine; Medicine & Public Health; Neurology; Neuroradiology; Neurosurgery; Patients; Posture; Prospective Studies; Psychiatry; Quality of life; Questionnaires; Randomized Controlled Trials as Topic; Review; Review Article; Side effects; Systematic review; Tremor; Tremor - drug therapy; Shaky legs syndrome; Pharmacological treatment; Prospective trials; Orthostatic tremor
• ISSN: 1590-1874; 1590-3478; 1590-3478
• DOI: 10.1007/s10072-025-08129-3

Introduction Orthostatic tremor is an infrequent movement disorder characterized by a high-frequency tremor manifesting primarily in the standing position. This condition can lead to relevant restrictions of mobility in everyday life and adversely affect the quality of life. The etiology has not been conclusively clarified. To date, there are few therapy studies of sufficient quality. Aim The aim of the present literature analysis is to systematically evaluate the existing evidence of pharmacological therapies for orthostatic tremor. Materials and methods This study searched for publications via PubMed and Google Scholar using the terms “orthostatic tremor” AND “therapy” and “shaky legs syndrome” AND “therapy”. The main inclusion criteria were a subject number ≥ 5, pharmacological treatment approaches and the presence of a prospective experimental design. Results The evaluation of the results indicated the most positive evidence for therapy with gabapentin. Additionally, other drugs such as perampanel and levodopa also showed positive outcomes regarding specific endpoints. In contrast, there is a lack of evidence supporting the efficacy of levetiracetam and botulinum toxin in the context of primary orthostatic tremor. Discussion and conclusion According to current evidence, gabapentin is the drug with the most robust data. However, further studies are needed to support the evidence for different pharmacological therapeutic approaches for orthostatic tremor. Future investigations should emphasize larger sample sizes, placebo-controlled, double-blinded methodologies and a longer follow-up to be able to make more precise recommendations with greater generalizability.