Case notes

Anti-dopamine tremors

Neuro Medical Clinic, Mall Road, Saddar, Rawalpindi · Dr. Umar Zafar Ali, Neurologist & Medical Specialist

A lady diagnosed with Parkinson disease at various clinics for last 02 yrs. Severly anxious over her condition, marked tremors all over the body especially coarse irregular tremors left arm. Had little benefit from Sinemet and other medication.

MRI brain normal. Blood profile, metabolic profile, B12, VDRL normal. No evidence of wilson disease. Autoimmune encephalitis profile, ENA profile and csf examination normal. Anti neuronal profile done at our lab showed Anti-Titin ++. Ct scan whole body normal.

IV Methylprednisolone given with anxiolytics and supportive care. After two weeks of therapy marked improvement with disappearance of tremor. After six weeks patient able to perform all her work even without medication.

Possible anti dopamine encephalitis ?

Doing it properly

Little and often beats one long session. Keep to the stated frequency for at least two weeks before judging whether it is helping, and stop any movement that causes sharp pain rather than working through it.

Come in if

Symptoms are worsening, waking you at night, spreading to a new limb, or unchanged after four weeks. Walk in during clinic hours — Monday to Saturday, 11:00 am to 06:00 pm — and bring this guide and any reports with you.

A question about your own case is better answered by the doctor than by a guide. Message the clinic with your name and file number.

General education, not a prescription. Seek urgent care for sudden weakness, slurred speech, a first-ever fit, a face that has drooped, or the worst headache of your life.