What workup and management plan is indicated for patients with orthostatic tremor?

Work-up can include a surface EMG recording of the patient in multiple positions (i.e. lying, sitting, standing) with confirmation of high-frequency (~15hz) tremor in the standing position (after several minutes of standing, typically).

Regarding management, clonazepam, gabapentin, and propranolol are medications classically tried, though with little benefit.

According to a chart review of 184 Mayo Clinic patients:

"Of 46 medications trialed, 24 failed to provide any benefit. Benzodiazepines provi...