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Wednesday, December 4, 2013
Confirm diagnosis of PD
My mother-in-law has had "intentional" movement tremors for well over 5-years now. It started in the right hand, then progressed to more of a contracture in that hand and now she has foot-drop on the right side. The doctor said it is PD, but I thought "resting" tremors are the cardinal sign of PD. I`m not sure if she had cog-wheeling or not (I was not at the appointment). Would this truly be PD?
Even though the classic parkinsonian tremor is thought of as a resting tremor, there are numerous patients with Parkinson's disease (PD) that have a non-resting tremor or even no tremor at all.
The cardinal features of parkinsonism include:
1) Bradykinesia (slowness of movement)
2) Rigidity (increased tone with passive range of motion)
3) Postural instability (decreased balance)
The presence of these features suggest parkinsonism. However, in addition to idiopathic PD, there are secondary causes of parkinsonism and also the atypical parkinsonian syndromes that can also present with these features as well. The absence or presence of these cardinal features have to be put in context with a patient's history and other examination findings to lead to a proper diagnosis.
I am unable to speculate further on your mother-in law's diagnosis without interviewing and examining her. However, I encourage you to discuss her symptoms with her doctor and even consider asking for a referral to a specialist if not already done.
Punit Agrawal, DO
Assistant Professor of Neurology
College of Medicine
The Ohio State University