Parkinson’s Disease: Its Over-Diagnosis and Under-Diagnosis

In this era of genuinely marvelous, high-tech, medical devices, it’s occasionally surprising that particular illnesses are still diagnosed “clinically,” meaning that the clinician makes the call based on just the story of symptoms and also the physical exam. Parkinson’s Disease is 1 such illness. There’s no “Parkinson scan” or “Parkinson blood-test” to rely upon. MRI scans, CT scans and blood tests are generally regular in individuals with this illness.

Obviously, as soon as upon a time–before scans and blood-tests even existed–this is how all diagnoses had been created. So, in a sense, diagnosing Parkinson’s Disease gets back to the extremely roots of what doctors are supposed to do. But when you will find no corroborative tests obtainable to prove or disprove a diagnosis, even the physician occasionally gets it wrong.

Prior to delving into the challenges of diagnosing Parkinson’s Disease, let’s initial think about what’s recognized about this condition.

In 1817 James Parkinson, an English surgeon and apothecary, published a classic, short book entitled “An Essay on the Shaking Palsy.” In it, Parkinson identified a consistent pattern of physical abnormalities in six patients he had examined. Even though individuals with identical abnormalities had doubtlessly been around for thousands of years, Parkinson was the very first to recognize this pattern of abnormalities as a distinct condition. For this essential achievement, the illness was ultimately named for him.

Within the book’s opening sentence Parkinson wasted no time in laying out prominent functions of this illness: “Involuntary tremulous motion, with lessened muscular power, in parts [of the body] not in action as well as when supported; having a propensity to bend the trunk forwards, and to pass from a walking to a running pace: the senses and intellects becoming uninjured.”

Subsequently, scientists discovered that degeneration of a limited group of brain cells containing the chemical transmitter dopamine was responsible for these clinical modifications. (The group of brain cells involved is too slight to show up on brain scans in all but probably the most advanced of instances.)

In 1967, levodopa (1 of two ingredients in brand-name Sinemet) a drug the body can convert into dopamine, was discovered useful in alleviating numerous of the symptoms. Later, other drugs (dopamine agonists) had been produced that improved symptoms by mimicking the action of the missing dopamine. These consist of bromocriptine (brand name Parlodel), pergolide (Permax), pramipexole (Mirapex) and ropinirole (Requip). To date, you will find no remedies that reliably quit or reverse the underlying disease-process.

As a condition that affects about 1 percent of individuals over the age of 60, Parkinson’s Disease is generally on the radar screen of patients and doctors alike when new symptoms are present that suggest the illness. That other conditions can resemble it was not news to James Parkinson who devoted a chapter of his 1817 book to “Shaking palsy distinguished from other illnesses with which it might be confounded.”

In my consultation practice of neurology, I see both over-diagnosis and under-diagnosis of Parkinson’s Disease. The issue generally centers on 1 of probably the most visible of symptoms, the tremor. When tremor of the hands is present, doctors frequently diagnose Parkinson’s Disease, even when an additional condition would be to blame. When tremor is absent, doctors frequently fail to think about Parkinson’s Disease, even when it’s present.

1 key to accurate diagnosis would be to focus on the characteristics of the tremor itself. The Parkinsonian tremor generally affects 1 hand initial, and at all stages of the illness the initially affected hand remains much more tremulous than the other hand. And, as Parkinson himself emphasized, the tremor is most evident when the hand is at rest or supported, and decreases when the hand is within the air or put to make use of. In other conditions that trigger hand-tremors, the hands are much more equally affected, and also the tremor is much more evident when the hands are within the air or put to make use of.

What about instances in which no tremor is present? Simply because symptoms of Parkinson’s Disease worsen slowly–year by year rather than month by month–patients and their families frequently mistake these modifications as because of regular, wholesome aging.

Non-tremor symptoms of Parkinson’s Disease can consist of relative immobility of body-parts (hypokinesia), particularly of the face which can show a mask-like lack of expression. Movements, as soon as initiated, are slow (bradykinesia). Walking, as James Parkinson noted, entails a bent-forward posture with shuffling, short actions and decreased swinging of the arms. Occasionally the body’s center of gravity gets ahead of the feet’s capability to catch up, resulting within the passing “from a walking to a running pace” that Parkinson described and is recognized as festination.

The physical exam also shows clumsiness in hands and feet. Increased muscle tone, known as “rigidity,” is encountered within the patient’s neck and arm muscles, even whilst they’re supposed to be relaxed.

Patients who have Parkinson’s Disease with out tremor are frequently probably the most gratifying instances to treat. Having developed their issues slowly and having believed all along that their symptoms had been because of aging, they’re happily astonished by the rapid improvement in function produced by suitable medication.

(C) 2005 by Gary Cordingley