title: Writing tremor secondary to ischemic stroke: a report on a case with a remarkable response to topiramate.
abstract: Writing tremor (WT) is a task-specific tremor that occurs only or mostly while writing with the dominant hand. Secondary cases are extremely uncommon. We report on a patient who, after developing a WT after an ischemic stroke, had a remarkable response to topiramate (TPM).
  
  
  METHODS
  A 65-year-old right-handed man with a history of arterial hypertension, dyslipidemia, and coronary heart disease presented dizziness and headache followed by a loss of consciousness and then a right hemiparesis. He regained his strength on the fifth day. Fourteen days after stroke, he developed a WT as well as other complications with activities such as welding (he is a welder) and using a spoon. He was treated with 50 mg/d of TPM with marked improvement in WT. A few weeks after TPM was discontinued, the WT symptoms reappeared and he was retreated, showing the same beneficial reaction.Electromyographic record showed a 5- to 6-Hz tremor in his right hand, and a magnetic resonance imaging showed bilateral small frontoparietal subcortical infarcts.
  
  
  CONCLUSIONS
  Primary WT pathophysiology is not well known, and secondary WT as a result of stroke is even less considered. Although patients with essential tremor benefit with TPM and WT could be a variant of essential tremor, we used TPM with our patient and there was a marked benefit.
authors.affiliation: Parkinson's Disease and Movement Disorders Program, Hospital de Clínicas José de San Martín, University of Buenos Aires, Buenos Aires, Argentina.
authors.forename: Juan P
authors.initials: JP
authors.lastname: Paviolo
authors.forename: Gabriela B
authors.initials: GB
authors.lastname: Raina
authors.forename: Eugenia
authors.initials: E
authors.lastname: Conti
authors.forename: Federico
authors.initials: F
authors.lastname: Micheli
mesh_terms: D000368:Aged; D000927:Anticonvulsants / Q000627:therapeutic use*; D002545:Brain Ischemia / Q000150:complications; D002540:Cerebral Cortex / Q000473:pathology; D004576:Electromyography; D005632:Fructose / Q000031:analogs & derivatives* / Q000627:therapeutic use; D006236:Handwriting; D006801:Humans; D008279:Magnetic Resonance Imaging; D008297:Male; D020521:Stroke / Q000150:complications* / Q000209:etiology; D000077236:Topiramate; D014202:Tremor / Q000188:drug therapy* / Q000209:etiology*
chemical_list: D000927:Anticonvulsants; D000077236:Topiramate; D005632:Fructose