Age: 37 Height: 5 feet, 10 inches Issue: * Tremor specially in thumb when writing and in wrist when hold some thing. Tremor in left hand is more than in right. * Stiffness in lower back. The problem is by birth. I am feeling pain in low back. In this regard, did MRI, report of which is as below: Sagittal and axial T1W and T2W sequences acquired through lumbosacral spine. L5/S1 disk is dehydrated. L4/5 disk shows minimal circumferential bulge causing negligible indentation of thecal sac and minimal compromise of existing nerve roots. L5/S1 disk shows braod-based bulge causing mild compression of thecal sac and minimal compromise of right existing nerve root. Other disks are within normal limits. Vertebrate show normal height and marrow signal. Conus medullaris is normal. Few sections through secroilian is normal. Few sections through sacroiliac joints reveal no significant abnormality. ----------------------------------------------------------------- * Sometime dull pain in calf, sometime cramps, sometime knee pain, after analgesic it relieves and some time feel knee fraction. However after exercise the pain disappears. Pain and fraction mostly in winter season. * Hyper reflex in lower limbs with tick bite. * During walking can t pick feet preperly, walking with drop toes, stike with stairs or when uneven surface, bit uneasy down the stairs. No proper knee joint movement in winter season and also there is a jerk in right leg which becomes absent or minimum in the morning. As the day passes it increases and feel comfortable on slope or decline place without leg jerk. *Headache with or without pain of right or left eye and also sometime with neck stifness involvement and sometime with nausea or vomiting, sometime cluster headache and sometime migraine and tension. * Feels also hands and arms stifness during writing, hand tremor increases in standing position and better when there is fore arm support. *Differential diagnosis (D/D) Myasthenia Gravis * Test: 1. Uric Acit - Report Negative 2. RA Factor - (Rheomatoid Arthritis) Negative ............................................................... * When lay down straight on spine feet a bit pressure or trachia or sometime in any position. * RX (Treatment got) 1. Tab. Betnisol - 0.5mg (Betnisone HCL) - 01 OD for 7 days. 2. Tab. Eprison - 50 mg (Eprison HCL) - 1/2 + 1/2 for 15 days. 3. Tab. Topiro - 25 mg (Topiromate HCL) - 1/2 + 1/2 for 15 days. For Tremor 1. Tab. Inderal 40 mg (beta blocker) 1/2 + 1/2 2. Campro (Procyclidine) 1/2 + 1/2 Feet bit better during use of tab. betnisol. After 15 days again had to go for further consulation but couldn t. Also this treatment temporarily effects the eye sight. Sir, your kind advise is required in this regard. Regards. Majid Gilani