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Confirmation of the diagnosis of Parkinson's Disease (PD)
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DUKE MEDICINE
Mark A Stacy, MD posted:
At this time, there is no confirmatory test for PD. The best testing we have is functional brain imaging to assess dopamine concentration in the "basal ganglia" or "striatum." This area of the brain demonstrates a decrease in dopamine concentrations with PD, and may be imaged using a Positron Emission Tomography (PET) scan or a SIngle Photon Emission Computed Tomography (SPECT) scan. PET scanners with dopamine-type imaging are not widely available, and dopamine scanning with SPECT is not available in the United States at this time. However, a SPECT imaging molecule may be approved in 2010, and there are others in development for use in the US.

Short of functional brain imaging, Neurologists look for signs and symptoms associated with PD to lead to diagnosis. Early symptoms include: resting tremor, difficulty with handwriting, dressing, cutting food, and other fine motor tasks. It is also helpful to see if one side of the body is more affected than the other.

Early signs are termed "cardinal characteristics," and include resting tremor, bradykinesia (slowness of movement), and rigidity (stiffness of the limbs, when moved through a range of motion by the examiner). If two of three of these signs are present, there is a 70% chance that the condition is PD.

The next step is to treat with medication, and if a significant benefit is seen, the chance that it is PD increases to 90%. Before initiating therapy, it is important to define these expectations, and remember, if you barely show signs of PD, you may not show a dramatic or significant improvement. In addition, the medications suggested in early PD, differ significantly from the medications used in more symptomatic PD. I prefer to start drugs that may slow disease progression in many patients, particularly in very mild cases, and use more potent therapies later.

If there is no symptomatic benefit, you should discuss other possibilities with your doctor. I would consider brain imaging in some instances. Symptoms that lead to other diagnostic concerns include: frequent falling as a first sign or early in the disease, double vision (particularly when reading), frequent crying or laughing at minor things, a hand that seems to have a "mind of its own" or that will not move the way a patient wants it to move, urinary incontinence, or significant memory disturbances. In addition, a highly symmetric presentation (both sides affected equally), or lack of tremor will push me to consider other diagnoses.
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njladyluck responded:
Thank you Dr. Stacy for the sharing of your knowledge in this format and your compassion!! I was diagnosed with PD 7/7/10 and have an appointment with a movement specialist on 9/8/10. I have had an MRI of my brain and spine along with a physical testing and blood work that assisted the general neurologist to dx PD. I chose not to take meds right now. I was wondering about this quote from above, "I prefer to start drugs that may slow disease progression in many patients . . .." I have been hearing and was told by the gen neurologist that medicine does not slow the progress of the disease just helps control the symptoms. Does it or does it not stop the progression of PD.

I am 61 years and my complaints were resting tremors, slowness, about a year ago freezing of the lower leg when beginning to walk and mouth when beginning to talk but both only happened a few times. Lost sense of smell years ago, choking when sipping drinks and sleeping on back, etc. I am a secretary and still work.

Also 2 things I want to know from upcoming drs. appt. (1) what stage am I in and (2) do I have the so-called "elderly" PD that seems to be more aggressive or I have heard the term PD Plus. What other questions should I ask my movement specialist that would help me understand what I have and where I am at now and if I should be taking meds.

After an incident at work this week (hard time typing with 1st 3 fingers of left hand) I have a prescription for an occupational therapist. I have started an aggressive exercise regime of fast walking 18 miles a week, yoga, tai chi, zumba. I feel my tremors are better, certainly have more stamina, and feel a little bit like I have some control. I do not understand what happens to the muscle when you have PD does it slacken because the mind doesn't tell it to work? Would weight lifting help?

So many questions lol. Thank you for your answers and help.
 
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An_221441 responded:
Dear Dr. Stacy,
Thank you for sharing this important information. I was not diagnosed with PD until 2/2010 after almost a year of tests and alarming predictions, such as "I think you have ALS" from my PCP.
Formal diagnosis was made mainly by seeing if I responded to Carbo-levo 25-100, to which I had significant response in bradykinesia and rigidity. I have always had significantlly left-sided disease.My problem now is that I have developed a rather significant dystonia in my L foot, with much cramping in the arch and toes, plus turning under or "clutching" of the toes, beginning with the second toe (now hammer toe), but now also prevalent in the big toe and extending to all toes at times. I am now experiencing considerable neuropthy in the foot and ankle, mostly numbness and tingling, which comes and goes, and sort of runs up my leg at times. I have found that going barefoot or just with socks around the hosue helps the cramping tremndously, but not so much the neuropathies.
I also purchased and wear the new "barefoot shoes" called "Five FIngers". They are great. My foot responds negatively to any shoe with arch support, etc. I walk on the treadmill everyday for 1/2 hour in addition to other exercises, but nothing else specifically for my foot.
I wonder if you might comment on the foot dystonia-do you see this often in PD, any suggestions on other meds (am taking, carbo-levo, gabapentin and pramipexole, all tid) Exercises? How bad will this get? Expectations for the future?

Many thanks,
leepenn3
 
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DUKE MEDICINE
Mark A Stacy, MD replied to An_221441's response:
Hello again, Leepenn3
I addressed a bit of the foot cramping in a previous reply. Exercise, really stretching, will help the foot cramping. The barefoot shoes is a neat trick - "sensory trick" is something associated with dystonia, and may be the reason these help.

I would not assume you have a "neuropathy" unless there has been an EMG/NCV to verify the diagnosis.


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