Objective: To report unusual presentation of Young-Onset Parkinson’s disease with disabling hip and trunk rest tremor resembling “belly dance”.

Background: Proximal tremor is not commonly observed in Parkinson’s disease. Abdominal tremor has been reported in variety of conditions such as cerebellar tremor, thyrotoxicosis and rarely seen in Parkinson’s disease. Previously, Belly dancer’s dyskinesias is previously described due to neuroleptic exposure or levodopa related dyskinesia in Parkinson’s disease or functional movement disorder.  Proximal rest tremor involving the hip and trunk has not been reported in Parkinson’s disease with excellent response to levodopa medication and also to deep brain stimulation.

Method: Case report

Results: 46-year-old-man with known diagnosis of young-onset Parkinson’s disease, with onset of symptoms at age 33. Initial symptoms were slowness in walking, tremor in hip, mostly on the left side which causes difficulty in walking and muscle tightness in legs, left more than right. Non-motor symptoms included constipation and anosmia. Patient has family history of Parkinson’s disease but unfortunately gene testing could not be performed.  OFF state UPDRS improved from 50 to 11 after levodopa challenge. In OFF state, patient has left leg rest tremor with prominent hip/truncal tremor at rest with accompanied bradykinesia and rigidity. Patient was on Stalevo (150-37.5-200) and Sinemet (25-100), 1 tablet every 3 hours with total levodopa dose of 1750 mg per day. He had prominent motor fluctuations with dyskinesia. After multidisciplinary team meeting, he had deep brain stimulation of bilateral STN. With subsequent DBS programming sessions, he had significant improvement in tremor with DBS, being followed up for 16 months, and he was able to reduce the dose to 700mg per day.

Conclusion: We report the first case of hip rest tremor resembling “Belly dance tremor” in Parkinson’s disease patient with excellent response to bilateral STN DBS.

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MDS Abstracts - https://www.mdsabstracts.org/abstract/belly-dance-tremor-hip-and-truncal-tremor-in-parkinsons-disease/