Infantile tremor syndrome usually occurs in Indian subcontinent and C/B coarse tremors along with signs and symptoms of megaloblastic anemia. Recently I have seen a case of ITS, 6 month old female child presented to me with coarse tremors, bleating cry, sparse hairs, knuckle hyperpigmentation along with severe pallor. Peripheral blood smear showed MCV 102 along with HB- 6.5. Her Vit B12 levels also decreased. CT scan showed cortical atrophy along with corpus callosal thinning. We have started Vit B12, Iron, Zinc and supportive treatment but tremors not improved rather increased than we have started carbamazepine. There was dramatic improvement after 3 days of CBZ.