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A 71-year-old man was referred with worsening involuntary tremulous movements in the left hand. He had no history of dementia or epilepsy. He had undergone surgery for cervical myelopathy at the age of 50 years. He later noticed tremulous movements of left hand, which mildly affected his daily life. When aged 57 he had a fall, after which the limbs movement worsened and he required a wheelchair.
In the year before his assessment, he had developed difficulty in picking up objects with the left hand because of the increasing involuntary movements, occurring more than 10 times per day, and particularly in the morning. Movements were induced by moving the left hand or forearm, when the hand or forearm hit an object (figure 1 and online supplemental video 1), when he felt nervous or when he yawned. The movements stopped when the left hand held on to something or when he grasped an object. If he did nothing, the movement could last for a long time. Treatment with baclofen (10 mg/day) and clonazepam (1 mg/day) gave only minimal improvement.
Supplementary video
Video showing left hand movements or tactile stimulation can induce the clonus. Segment 1. Clonus induced by the patient opening and closing both hands. …
Footnotes
Contributors YS is guarantor. YS drafted the manuscript, obtained medical history and materials. All authors were involved in drafting and reviewing the manuscript.
Funding The authors have not declared a specific grant for this research from any funding agency in the public, commercial or not-for-profit sectors.
Competing interests None declared.
Provenance and peer review Not commissioned; externally reviewed by Sarah Furtado, Calgary, Canada.
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