case_images: PMC10198224_01
case_images: 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.. Three months after VPA discontinuation. The patient's-tremor completely disappeared and several maneuvers showed no apparent abnormality.
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case_images: PMC10198224_01_.jpg
case_images: V1
case_images: Serum concentration of VPA was 60.8-67 microg/mL for an extended period, but rose prior to symptom onset and gradually increased in a time-dependent manner (Figure 1A). Electroencephalography showed no epileptic discharge and brain magnetic resonance imaging showed only minor ischemic change (Figure 1B, C). Because [123I]b-CIT single-photon emission computed tomography (SPECT) showed no reduction in dopamine transporter (DaT) activity (Figure 1D), he was suspected of having valproate-induced tremor and mild parkinsonism.