Video 4.

Progressive supranuclear palsy (PSP) with levodopa‐induced dyskinesias. Segment 1 shows a 79‐year‐old Indian male with PSP‐P with corticobasal syndrome (CBS) overlap who developed an unusual complication of levodopa therapy. He presented with slowing more on the left and noted abnormal posturing and inability to use his left arm soon after. He experienced recurrent fall 6 years later. The video taken 10 years after onset shows vertical gaze palsy and right hand bradykinesia and astereognosis. The left hand was held in a fixed dystonic posture. He had an interesting dyskinesia involving only the tongue, that occurred after levodopa escalation. Segment 2 shows a 76‐year‐old Gujarati patient with PSP‐RS who developed levodopa‐induced dyskinesias. She presented initially with difficulty with left hand use but suffered recurrent falls within 3 years. She experienced generalized dyskinesia 5 years later, while on low dose Sinemet 62.5 mg low dose levodopa (150 mg daily) [TDS]. The video taken 6 years after onset shows frontalis overactivity, apraxia of eyelid opening, vertical gaze palsy, asymmetric limb bradykinesia, dystonia and apraxia, worse on the left. Her dyskinesias, while generalized, were also worse on the left.