Article type: Letter to the Editor
Article title: Slow Orthostatic Tremor Associated with Diabetic Neuropathy: A Case Report
Journal: Current Medical Issues
Year: 2026
Authors: Jamir Pitton Rissardo and Ana Leticia Fornari Caprara
E-mail: jamirrissardo@gmail.com
ABSTRACT
Slow orthostatic tremor (OT) is a rare movement disorder characterized by lower-extremity and trunk tremor during standing with a frequency below 13 Hz. We report a 68-year-old woman with insulin-dependent type 2 diabetes mellitus who presented with a 5-month history of progressive bilateral leg tremor occurring predominantly while standing, improving with walking, and resolving when sitting. Neurological examination revealed standing-induced leg and torso tremor, impaired tandem gait, and length-dependent sensory loss without parkinsonism. Electrophysiological studies demonstrated a diffuse length-dependent predominantly axonal sensorimotor polyneuropathy consistent with diabetic neuropathy and a 10–12 Hz tremor that abated with sitting. Extensive laboratory testing, brain and spine magnetic resonance imaging, electroencephalography, and clinical evaluation excluded alternative causes, including primary orthostatic tremor, Parkinson’s disease, orthostatic myoclonus, chronic inflammatory demyelinating polyradiculoneuropathy, functional tremor, structural lesions, metabolic disorders, and epilepsy. Treatment with clonazepam 0.5 mg daily resulted in partial symptomatic improvement. Although a causal relationship cannot be definitively established, diabetic neuropathy was the only identifiable comorbidity and may have contributed to tremor generation. This case highlights a rare association between slow OT and diabetic axonal sensorimotor polyneuropathy and underscores the importance of electrophysiological assessment in patients presenting with standing-induced lower-extremity tremor.
Keywords: orthostatic tremor; diabetic neuropathy.
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DOI
Citation
Rissardo JP, Caprara AL. Slow orthostatic tremor associated with diabetic neuropathy: A case report. Curr Med Issues 2026;24:433-5. doi: 10.4103/cmi.cmi_38_26.
Figure 1. Electromyography showing length-dependent axonal sensorimotor polyneuropathy with chronic denervation. Preserved proximal conduction and normal F-wave suggest no generalized demyelinating process. NCV: Nerve conduction velocity.
Table 1. Differential diagnoses considered and rationale for exclusion.