Improvement of Primary Writing Tremor in Parkinson’s Disease with Carbidopa/Levodopa

BACKGROUND: Primary writing tremor is a task-specific phenomenon that has been described as variants of essential tremor or dystonia. PHENOMENOLOGY SHOWN: We describe the case of a 63-year-old female who initially had primary writing tremor, later developed Parkinson’s disease, and once initiated on carbidopa/levodopa had improvement in her parkinsonism and her writing tremor. EDUCATIONAL VALUE: As neither essential tremor nor typical brachial dystonia respond to carbidopa/levodopa, our case documents that at least some cases of primary writing tremor are not variants of either dystonia or essential tremor.