An 84 year old gentleman presented for evaluation of abnormal movements he has had for 40 years. He reported tremor in his hands, legs as well as head; worsening of his gait over the last few years; intermittent curling of his toes bilaterally; orthostatic symptoms as well as urinary urgency. He had worsened cognitive functioning as well. Previously he had been diagnosed with Parkinson’s syndrome. Levodopa trial did not provide with significant improvement of his symptoms. He reported three of his siblings (2 sisters and 1 brother) had similar abnormal movements. On physical exam, he had multidirectional head tremor, bilateral hand rest, action and postural tremor. He had symmetric bradykinesia bilaterally on finger tapping, cogwheel rigidity in all extremities and had involuntary chewing and lip smacking orobuccal movements. He had stooped posture with short strides and walked with a walker. Peripheral blood smear revealed presence of acanthocytes. Dopamine transporter reuptake–SPECT (DAT) scan was normal. MRI brain did not reveal intracranial issues. Genetic workup revealed homozygous ATM gene mutation (pV2716A variant) which was consistent with adult onset Ataxia Telangiectasia. Patient was tried on Amantadine but did not report significant improvement with motor symptoms.