This 70-year-old man suddenly developed bilateral leg tremors about a year prior to this evaluation. The tremors were present mostly when sitting throughout the day. Two months later, as he was tried on levetiracetam, the tremors were suddenly “transferred to the upper body” and mostly disappeared in the legs. He also developed intermittent jerking of the left arm, but may also have similar jerking of the right. About 4 months later, he started to experience stumbling with walking although he had no falls. This problem kept him from playing golf. He had been treated for depression and anxiety for about 2 years but reported that trials with paroxetine, escitalopram, and venlafaxine were of no benefit to him. He continued to work at his own health insurance
company but admitted to a growing list of unfinished responsibilities and problems with personnel.