Comments to “Orthostatic tremor secondary to recreational use of solvents”

Dear Editor:

It was with great interest that we read the letter to the editor “Orthostatic tremor secondary to recreational use of solvents”, where Cruz Tabuenca et al.¹ highlighted a little known secondary effect of the recreational use of organic solvents, orthostatic tremor (OT).

During the 67th annual meeting of the Spanish Society of Neurology,² we presented the cases of 3 patients with OT secondary to treatment with dopamine receptor–blocking agents (2 cases treated with levosulpiride and 1 with risperidone), who responded well to treatment withdrawal and to therapy with clonazepam and gabapentin, and typical and confirming EMG readings of tremor. The real aim of our case report was to increase the level of suspicion of this rare condition, since patients seek care due to gait instability (which responds well to symptomatic treatment) and not to tremor. Other authors have highlighted that patients with OT also experience dizziness³ or gait instability,⁴ as was the case of the patient reported by Cruz Tabuenca et al.,¹ who visited the emergency department due to a 2-year history of gait disturbances and frequent falls.

Delays in the diagnosis of OT are also surprising. The most extensive series of OT cases was published in Neurology in January 2016.⁵ In this series of 184 patients from the Mayo Clinic, diagnostic delay surprisingly reaches a mean of 7.2 years, and the rate of falls is strikingly high (24.1%).

We would like to congratulate the authors; their article is helpful for clinical practice as it increases the level of suspicion of OT in patients reporting gait disturbances.

Funding

The authors have received no private or public funding for this case report.

Conflicts of interest

The authors have no conflicts of interest to declare. This article has not been submitted for review by another publication.