Suppressed at rest, noticeable when attempting tasks that require fine motor movements
History / PE:
Writing illegibly
Inability to hold newspaper
Treatment:
Propranol Primidone or topiramate (2nd line)
Notes:
P rimidone (anticonvulsant) can precipitate acute intermittent porphyria (abdominal pain, neurologic and psychiatric abnormalities), which can be diagnosed by checking for urine porphobilinogen
