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mds21685-MDS21685.mpg12243KSegment 1. Patient 1: There is some facial hypomimia, a pronation-supination rest tremor of the right hand, and a vertical jaw tremor. On flexing the outstretched arms, there is dystonic elevation of the right upper arm and shoulder and her head tilts to the right. There is irregularity, but no fatiguing or decrement, of repetitive movements. There is decreased right arm swing when walking. On follow-up, there is postural tremor and clear dystonia of the right arm when keepings the arm outstretched with the elbows flexed.Segment 2. Patient 2: A rest tremor of the right hand is observed involving the thumb, which is extended. With arms outstretched, there is an elevation of the right shoulder and mild postural tremor and dystonic posturing of both hands. There is no fatiguing or decrement of repetitive movements.Segment 3. Patient 4: There is a pill-rolling rest tremor involving the thumb and the index finger, with thumb extension, on the right and a milder rest tremor of the left arm. She has a jaw tremor and a side-to-side head tremor. There is dystonia of the patient's outstretched arms, more on the right. There is no fatiguing or decrement on repetitive movements. When walking, there is slightly reduced arm swing bilaterally and a tremor of her right hand. When talking, there is laryngeal dystonia, some upper facial tremor, and more florid dystonia of both hands.Segment 4. Patient 7: This segment shows rest tremor of the right hand with thumb extension, which is one of the characteristic features in many of these cases (see Table 2).Segment 5. Patient 10: There is bilateral, right more than left, and tremor at rest. On writing, she has dystonic posturing of the left index finger and exacerbation of the tremor. The flurries of tremor evident on certain tasks are again a characteristic feature of note in some cases (see Table 2).

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