A 62-year-old man comes to the clinic with a 30-year history of severe tremor affecting both hands. In addition, he states the tremor affects his voice and he describes some head tremor. He states he has become a social "shut-in." He is embarrassed to go out in public and he is unable to work. He is unable to feed himself or drink from a cup. He now has significant difficulty even using the restroom without his wife's assistance. He has tried several medications, including Mysoline and In-deral prescribed by a neurologist specializing in movement disorders. He has been unable to tolerate these medications and he claims they had minimal to no influence on his tremor.
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