We appreciate the letter by Benito et al. emphasising the possible association between orthostatic tremor and vitamin B12 deficiency, which highlights the causal association between these 2 entities and the existing literature on this subject.1–6 Indeed, being aware of this association, and given the medical history of the patient, we did review her vitamin B12 levels. At the time they were between 249 and 421pmol/l (132–857) and mean corpuscular volume was around 85fL (80–96) in successive analyses conducted between 2006 and 2009, when we first started treating her.
The patient had a history of gastric neoplasm in 2006 that required total gastrectomy and cholecystectomy, as well as monthly intramuscular supplements of vitamin B12, from 2006 until the present time. However, the clinical onset of instability in the lower limbs took place in 1996, 10 years before the history of gastric neoplasm and subsequent gastrectomy that caused the vitamin B12 deficit.
Nevertheless, it is important to bear in mind this association and we wish to thank Benito et al. for highlighting this potential causal inference, given the reversibility of orthostatic tremor after treatment and replacement of vitamin B12 levels.
Please cite this article as: Yagüe S, et al. Importancia del estudio electromiográfico en el diagnóstico del temblor ortostático. Réplica. Neurología. 2011;27:122.
