Video 1
Initial presentation of this case. The patient showed right hand-dominant resting tremor. When he raised both arms, his tremor was not exacerbated and was rather suppressed in the left arm. Finger tapping and pronation-supination movements of the hands showed broken regular rhythm or sight slowing. Posture and gait were almost normal, but right-dominant tremor continued when walking.
Figure 1
A) Bar graph shows changes in the serum concentration of valproic acid (VPA). The serum concentration of VPA was stable for long time, but rose preceding symptom onset (arrow on the lefts), and then gradually increased. The patient’s serum concentration was highest (100.4 μg/mL) at the time he visited our clinic (arrow on the rights). B), C) Brain magnetic resonance imaging showed only minor ischemic changes. D) [123I]b-CIT single-photon emission computed tomography showed no evidence of nigrostriatal degeneration.
Video 2
Three months after VPA discontinuation. The patient’s-tremor completely disappeared and several maneuvers showed no apparent abnormality.