Questions posted in the Neurology and Neurosurgery Forum have been answered by doctors from The Cleveland Clinic Foundation.

Question Title: COULD THIS BE PARKINSON'S DISEASE?

Forum: Neurology Forum
Topic: Parkinson


For about 5 years I have been suffering from
symptoms which I have recently learned, "could" be
consistent with symptoms of early stage Parkinson's
Disease: Stiffness of my neck, back and shoulders,
increasing balance difficulties, and most recently
my toes and fingers (left side) have been moving
(or twitching) on their own. I have also begun to
have some actual muscle trembling, although it is
infrequent at this point. My left arm does not
swing when I walk, either, unless I am aware of
it...then I can MAKE it swing. In addition, I also
suffer from mild to moderate depression, constant
fatigue and difficulty with sleep.

I am 38 years old and recently have taken several
bad falls. I made an appointment with a Neurologist
in my area (he was NOT a Movement Disorder
Specialist..and see's primarily older PD
patients)..and the appointment did not go well. I
believe it was due to my age, but the moment he
heard me utter the word "depression", his eyebrow
went up and he suggested I get a good Psychiatrist.
I have suffered from depression for almost 10
years, but these other symptoms have troubled me
for only about half that time (5 years).

I feel that I am currently in LIMBO...and do not
know whether or not to pursue the PD angle. I have
heard that it is common for a younger PD patient
(whose symptoms may not be as obvious as an older
patient)..to have a large amount of difficulty
getting a doctor who WILL pursue and try to rule
out Parkinson's. Is this true, and should I try
again? The symptoms are becoming more difficult for
me to live with...especially the rigidity in my
back. Thank you for your time.


Dear Scott:

Sorry to hear about your symptoms. Early onset Parkinson disease is a rare finding, although Michael J. Fox has given us an example that it is possible. Actually, your symptoms have some of the flavor of Parkinson's but not the usual presentation. Usually, it begins with a resting tremor that has a characteristic rate and rhythm and describe as a "pill rolling" tremor. The tremor will vanish with action/movement. It is usually asymmetrical. There is also a facial "masking" that occurs early. The symptoms then become bilateral with the tremor, and a shuffling gait becomes prominent. At this point the postural reflexes are normal. The third stage of the disease is loss of postural reflexes. The disease progresses with the patient having difficulty getting out of chairs etc. One also sees a change in speech that is very striking as the disease progresses. There will be unnatural pauses, and decrease in modulation of emotion.

Putting these symptoms together with your description would lead me to think that you do not have Parkinson's disease. I would try and figure out what the etiology of your problems might be. A good thorough examination by a neurologist would be a starting point.

Good luck with finding the etiology of your illness.

Sincerely,

CCF Neuro[P]MD




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