Bilat UE Tremors

18WM 1yr hx Hand tremors, resting/intentional. Dystonia, hands flex. Episodes occur w/o warning, painless, unilat, L>R, 1-3hrs, w/ inc freq. Denies drug use or exposure to chemicals. Klonopin no help.  MRI mod atrophy for age esp posterior P/O; R occiput deformity w/flattening calverium & thinning cortex otherwise nl. Any distant trauma hx? By hx skull deformity present from birth. Labs nl
Age12 GilbertSyn yellow sclera. Wilson's has been ruled out. Age15 MVA Pt rode his bike into side of moving (32mph) auto, rolled over top car onto asphalt. Minor scrapes/bruises. No LOC. No apparent head trauma. CT read as nl. No MRI.
Age 17 Migraines dx'd. MRI read nl. Rx Immitrex w/ allergic rxn diaphoresis/SOB. H/A's do NOT precede above episodes. Above sx began many months after onset of migraines.
Birth/development nl. Fully immunized. Ear tubes age 1. Learning disability (reading)age 6, high average IQ, high math ability. Mild case German measles early childhood. L knee surgery age 12.
No significant FHx.  Mom RN. Dad distributes Ag chemicals.    

Family in Memphis. HMO doc "I haven't a clue." I'm an anesth MD
friend in DC.  My suggestion was Cleveland, Mayo Rochester, Harvard, JHU for movement disorder W/U. CIGNA HMO REFUSES. The HMO referral doc declined to see any patient that did not have Parkinson's. This is not my area of expertise.  Parents are desperately afraid for their child. They need direction and medical ammunition to demand HMO approval to go out of network to a major center. Can you help w/ this & comment on Etiol Tx/Rx and Prognosis. With gratitude.

[CCF-Neuro-M.D.-CS]

I would agree that the child needs to have a formal consultation with a neurologist who specializes in movement disorders. He needs to be evaluated for dopamine responsive dystonia, idiopathic dystonia, and other causes of basal ganglia dysfunction which could include a mitochondrial disorder, post-infectious, or a medication induced condition. Each of these disorders has a specific treatment and prognosis. I am not sure how much this will help, but I hope it dose. The parents should inform the insurance company that there specialist is refusing to see him, or see another neurologist who will endorse a specialist consult. Good luck