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Unilateral lower limb rest tremor is not necessarily a presenting symptom of Parkinson's disease

Authors

  • Mark A. Hellmann MD,

    Corresponding author
    1. Department of Neurology and Nuclear Medicine, Rabin Medical Center, Beilinson Campus, Petah Tiqwa, Israel
    2. Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
    • Department of Neurology, Rabin Medical Center, Beilinson Campus, Petah Tiqwa 49100, Israel
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  • Eldad Melamed MD,

    1. Department of Neurology and Nuclear Medicine, Rabin Medical Center, Beilinson Campus, Petah Tiqwa, Israel
    2. Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
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  • Adam P. Steinmetz MD,

    1. Department of Neurology and Nuclear Medicine, Rabin Medical Center, Beilinson Campus, Petah Tiqwa, Israel
    2. Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
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  • Ruth Djaldetti MD

    1. Department of Neurology and Nuclear Medicine, Rabin Medical Center, Beilinson Campus, Petah Tiqwa, Israel
    2. Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
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  • Potential conflict of interest: Nothing to report.

Abstract

Lower leg rest tremor is an uncommon symptom of neurological disease. Review of the files of 16 patients who presented with lower leg tremor (average age 58 ± 16 years; average disease duration 6.8 ± 8.5 years) yielded a diagnosis of Parkinson's disease (PD) in 5 and probable multiple system atrophy (MSA) in 3. In 4 patients with an indeterminate diagnosis, cardiac MIBG SPECT was positive in 3, indicating PD, and negative in one, suggesting MSA. Two patients each had psychogenic tremor and drug-induced parkinsonism. Although lower leg tremor is considered an unusual presentation of PD, it should raise suspicions of MSA and other neurodegenerative disorders. © 2010 Movement Disorder Society

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