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Abdominal Tremor in Parkinson's disease

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Authors:  Nobuyuki Tanaka MD, Toshihiro Hayashi MD, PhD, Shoji Tsuji MD, PhD and Atsushi Iwata MD, PhD

Article first published online:  24 FEB 2015 | DOI: 10.1002/mdc3.12119

A 66-year-old male visited our clinic with a 1-year history of walking difficulty and stomach shaking while lying down. Examination revealed very mild right-arm akinesia, bilateral leg rest tremor, and tremor in his abdominal muscles (see Video; Fig. 1A,B). Abnormal 123I-ioflupane single-photon emission CT (SPECT; Fig. 1C) and 123I-metaiodobenzylguanidine scintigraphy (heart-to-mediastinum ratio: 1.89) supported the diagnosis of Parkinson's disease (PD). Pramipexole was prescribed up to 3 mg/day, and his symptoms, including abdominal tremor, improved. Abdominal tremor is a rare symptom in PD. In addition, this might indicate that the presence of striatum somatotopy found in macaque monkeys are also present in humans.[1]

Surface electromyography recording at a supine position revealed 5 to 6 Hz rest tremor activities in the right rectus abdominis.Figure 1. (A) Surface electromyography recording at a supine position revealed 5 to 6 Hz rest tremor activities in the right rectus abdominis. (B) Upon forced calculation, the tremor worsened and spread to lower-extremity adductor muscles, which is a typical feature of parkinsonian tremor.[2] (C)123I-ioflupane SPECT study of the patient.


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