title: Unilateral lower limb rest tremor is not necessarily a presenting symptom of Parkinson's disease.
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.
authors.affiliation: Department of Neurology and Nuclear Medicine, Rabin Medical Center, Petah Tiqwa, Israel. markh@clalit.org.il
authors.forename: Mark A
authors.initials: MA
authors.lastname: Hellmann
authors.forename: Eldad
authors.initials: E
authors.lastname: Melamed
authors.forename: Adam P
authors.initials: AP
authors.lastname: Steinmetz
authors.forename: Ruth
authors.initials: R
authors.lastname: Djaldetti
mesh_terms: D003937:Diagnosis, Differential; D005260:Female; D007839:Functional Laterality / Q000502:physiology*; D006801:Humans; D035002:Lower Extremity / Q000503:physiopathology*; D008297:Male; D008875:Middle Aged; D010300:Parkinson Disease / Q000175:diagnosis* / Q000503:physiopathology*; D012720:Severity of Illness Index; D014202:Tremor / Q000175:diagnosis* / Q000503:physiopathology*