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Questions posted in the
Neurology and Neurosurgery Forum have been answered by doctors from The Cleveland Clinic Foundation.
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Subject: Re: Parkinson's Can you tell me what other disorders, aside from parkinson's causes pill-rolling? Can you also discribe pill-rolling? There is very little info on it. Thank you, Lynn = The tremor characteristic of Parkinson's disease is one which occurs while the limb (usually hand) is at rest. That is, the hand is in your lap or on the chair arm rest and it is shaking. The shaking resembles the motion you might make if you were to roll a ball of clay into a little pill between your thummb and forefinger. This is distinct from the (more common) postural-action tremor which is seen in people with Essential Tremor. In that form, the hands are held outstretched (maintenance of a posture) or are being used for some task (such as bringing a cup of water to your mouth) and exhibit a tremor. Not only is the tremor present in a different circumstance (posture vs rest), but the postural tremor does NOT look like a pill-rolling action. Next time you are very nervous, hold out your hands and observe the tremor and you'll see the difference. When I am confronted with a patient who has a characteristic resting tremor, I suspect Parkinson's disease. There is really very little else that looks like it. Some people with very advanced Essential tremor may exhibit tremor at rest, but they usually had it for a long long time and it isn't a mystery. Likewise, some people with damage to the cerebellum usually show a particular type of tremor but sometimes it can be seen at rest. Again, it usually isn't pill-rolling. Further, cerebellar damage is quite different than Parkinson's disease. Both produce abnormalities of motor control, but they are usually easy to tell apart (for the neurologist, that is). If you are suspicious of Parkinson's disease, see an experienced neurologist, preferably a movement disorders specialist. You are welcome to call 800 223-2273 and ask for neurology appointments at 4-5559. I hope this helps. CCF MD mdf.
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