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Vol. 27. Issue 2.
Pages 121-122 (March 2012)
Vol. 27. Issue 2.
Pages 121-122 (March 2012)
Letter to the Editor
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Letter with reference to the article “Importance of electromyographic studies in the diagnosis of orthostatic tremor”
Carta en relación con el artículo «Importancia del estudio electromiográfico en el diagnóstico del temblor ortostático»
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A. Labiano-Fontcubertaa,b, J. Benito-Leóna,b,c,��
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jbenitol@meditex.es

Corresponding author.
a Servicio de Neurología, Hospital Universitario 12 de Octubre, Madrid, Spain
b Departamento de Medicina, Facultad de Medicina, Universidad Complutense, Madrid, Spain
c Centro de Investigación Biomédica en Red sobre Enfermedades Neurodegenerativas (CIBERNED), Madrid, Spain
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Sir,

We read with great interest the article published recently by Yagüe et al.1 about the importance of electromyographic study in the diagnosis of orthostatic tremor. Our intention is not to assess the pathophysiological-diagnostic aspect of the article, brilliantly exposed by the authors who provide electromyographic concepts that demonstrate the growing and undeniable importance of electrophysiological analysis in the study of movement disorders. As the authors note, orthostatic tremor is an idiopathic motor disorder, although its possible association with pons lesions2 or cerebellar degeneration3,4 has been reported. Both of these constitute symptomatic forms of orthostatic tremor. It has been speculated that these anatomical structures (brainstem and cerebellum) could be directly involved in the pathogenesis and modulation of orthostatic tremor,5,6 in a manner similar to what might happen in essential tremor.7–9 We have noted that, in the case presented by Yagüe et al.,1 the patient presented a deficiency of vitamin B12 in her medical history, and this has motivated us to write this letter to highlight the possible association existing between orthostatic tremor and vitamin B12 deficiency. Eleven years ago, our group published the case of a patient with orthostatic tremor who also suffered vitamin B12 deficiency.10 While we recognise that this association is difficult to justify from the standpoint of biological plausibility, the fact that, following the reinstatement of the deficient vitamin, the tremor disappeared does strengthen this causal association. Since then, other cases have been published in which vitamin B12 deficiency has been associated with tremor.11,12 Furthermore, several neuroimaging studies have revealed abnormalities in the cerebellum and pons of patients with vitamin B12 deficiency.13,14 We believe these studies lend plausibility to the hypothesis of there being a causal inference between vitamin B12 deficiency and orthostatic tremor.

References
[1]
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Importancia del estudio electromiográfico en el diagnóstico del temblor ortostático.
Neurología, 26 (2011), pp. 53-54
[2]
J. Benito-León, J. Rodríguez, M. Ortí-Pareja, L. Ayuso-Peralta, F.J. Jiménez-Jiménez, J.A. Molina.
Symptomatic orthostatic tremor in pontine lesions.
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[3]
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Orthostatic tremor with cerebellar ataxia.
J Neurol, 245 (1998), pp. 815
[4]
M.U. Manto, F. Setta, B. Legros, J. Jaquy, E. Godeaux.
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Impact of different stimulation types on orthostatic tremor.
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[7]
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[8]
J. Benito-León, E.D. Louis.
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Nat Clin Pract Neurol, 2 (2006), pp. 666-678
[9]
J. Benito-León, J. Alvarez-Linera, J.A. Hernández-Tamames, H. Alonso-Navarro, F.J. Jiménez-Jiménez, E.D. Louis.
Brain structural changes in essential tremor: voxel-based morphometry at 3-Tesla.
J Neurol Sci, 287 (2009), pp. 138-142
[10]
J. Benito-León, J. Porta-Etessam.
Shaky-leg syndrome and vitamin B12 deficiency.
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[11]
S. Koussa, A. Taher, R. Sayegh.
Postural and kinetic tremor associated with vitamin B12 deficiency.
Rev Neurol (Paris), 159 (2003), pp. 1173-1174
[12]
S. Kumar.
Vitamin B12 deficiency presenting with an acute reversible extrapyramidal syndrome.
Neurol India, 52 (2004), pp. 507-509
[13]
V.K. Katsaros, F.X. Glocker, B. Hemmer, M. Schumacher.
MRI of spinal cord and brain lesions in subacute combined degeneration.
Neuradiology, 40 (1998), pp. 716-719
[14]
S. Morita, H. Miwa, T. Kihira, T. Kondo.
Cerebellar ataxia and leukoencephalopathy associated with cobalamin deficiency.
J Neurol Sci, 216 (2003), pp. 183-184

Please cite this article as: Labiano-Fontcuberta A, Benito-León J. Carta en relación con el artículo «Importancia del studio electromiográfico en el diagnóstico del temblor ortostático». Neurología. 2011;27:121–2.

Copyright © 2011. Sociedad Española de Neurología
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