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BACKGROUND: Orthostatic tremor is a rare disease characterized by difficulty with standing still. Patients often undergo a long diagnostic search and often feel underrecognized, partly due to unfamiliarity of physicians with the disease. CASE DESCRIPTION: We report a 72-year-old male experiencing difficulty in standing still, accompanied by a tingling, trembling and painful sensation in the legs, over the last ten years. Several orthopedic and neurological causes had been suspected until neurological examination revealed a 'helicopter sign' upon auscultation of the leg muscles. Tremor registration showed a 14 Hz tremor in the legs upon standing, confirming the diagnosis of orthostatic tremor. There was moderate improvement with pharmacological treatment. CONCLUSION: Orthostatic tremor should be suspected in patients with instability or atypical symptoms upon standing. A neurological referral including tremor registration is recommended in these cases.

Lumbar spondylolisthesis is usually asymptomatic. However, symptomatic spondylolisthesis results in back and/or leg pain such as radicular syndrome or neurogenic claudication. Variation in symptoms is caused by different types of spondylolisthesis. Lytic spondylolisthesis, most common at L5S1, is caused by spondylolysis of the pars interarticularis. This results in foraminal nerve compression and radicular symptoms. Degenerative spondylolisthesis, most common at L4L5 in patients >50 years old, is caused by slippage of the vertebral body and lamina, resulting in lumbar spinal stenosis and neurogenic claudication. Iatrogenic spondylolisthesis develops in 1.6-32.0% of patients after decompression surgery, causing recurrent neurogenic symptoms. It is important to understand the main symptoms patients experience: back or leg pain. In both cases, the preferred treatment is conservative. Surgery is only an option if patients have persistent/progressive leg pain. Shared decision-making is necessary to select the most accurate surgery for each individual patient while also taking into account age, comorbidities and symptoms. Further research is necessary to determine the advantages of each surgery in order to improve advice to patients.

Parkinson's disease (PD) is a neurodegenerative disorder characterised by tremor, rigidity and bradykinesia. The current treatment, for example with levodopa or dopamine-agonists, is complicated by response fluctuations, dyskinesias and gastro-intestinal side-effects. These, and various other reasons including fear of levodopa toxicity, have led to reluctance in starting medical treatment in PD. Especially during the last decade it has become clear that there is no scientific substrate for this reluctance. The aim should be to minimize the restraints in daily activity caused by PD, where medications including levodopa and dopamine-agonists have proven to be effective