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How does a doctor diagnose Parkinson's
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How does a doctor diagnose Parkinson's

I am a 51 yr. old female. I went to a neurologist because I had been having a loss of coordination on the left for approx. 6 months and a slight tremor for approx. 3 months. The tremor is not the type that occurs at rest. I happens when I reach for something or put weight on my leg. I have also noticed that I tense up my toes unintentually. My great toe starts trembling when I do this. The tremor gets worse when I am excited or nervous.

The doctor suspects Parkinson's. I couldn't tap my left index finger to my thumb fast while opening it fully each time. I also couldn't tap my left foot fast. He noticed an abnormal gait. I told him that I still walk with a slight limp since having total knee replacement 2 yrs. ago, but he may have seen something else. He ordered a liver test (blood) and an MRI. The MRI came back normal, but I don't know about the blood test yet.

Does Parkinson's show up on an MRI? If not, how does a doctor diagnose it? If it is Parkinson's and I start on medicine, will I eventually get used to it and have to switch or add more? Should I wait until the symptoms bother me more before starting medication?
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Avatar_m_tn
I think the tremor with PD occurs at rest and goes away when you do something and yours is different and could be essential tremor.  The lack of coordination should be followed, and one side only could be PD.  Does it come and go or it constant ? I assume the Liver tests were included for Wilson's Disease, it's rare but good to check it .  I don't think PD shows up on MRI but it rules out other things, but a SPECT CT might help.  A short trial of the Levadopa meds could be used for diagnosis purposes, but yea, waiting to start meds is better because they have nasty side-effects and don't help as much after a few years.  Do you feel very anxious?  maybe that's causing the tremor.  Also, anxiety can be caused by PD.  Hope that helps out a little.--GG
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Avatar_m_tn
Thanks for your comments. My MRI and blood test was normal. The doctor did another exam and says it is Parkinson's. Apparently some people have tremors other than the resting type or no tremor or all. The loss of coordination on the left side is constant. The doctor also noticed a problem with balance and when walking, I don't pick up my left foot as much as the right.

I have started taking Azilect 0.5 mg. I will increase that to 1 mg in a couple of weeks. I heard that taking Levodopa could help in the diagnosis. I know that Azilect increases Dopomine but maybe in a different way? Would it be enough to tell if I really have PD? As of now, after almost three weeks on the RX, I feel no difference. I will ask my doctor about this when I see him next time.
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Avatar_n_tn
Diagnosing PD is really done visually. There  are no definitive tests. The MRI would have been done to rule out any other abnormal condition, i.e. a stroke. No blood test shows a PD condition.

I'm 59 years old and was diagnosed two years ago. It's also a good idea to seek out a second opinion from a movement disorder specialist. I was diagnosed, sought out a second opinion, and then moved on to a movement disorder specialist. They specialize in body movement, and can distinguish various tremors and other movement conditions that make up a part of the PD world.

I've experienced some of the same symptoms you're having. I have tremor in my right arm extending down to my hand and fingers. I also experience cramping of my toes on the right side. And environmental factors do seem to impact my condition. I have no tolerance for cold. My tremor increases if I'm tense or nervous. I sometimes have a great deal of difficulty falling asleep. But these symptoms are all manageable.

I've been on 1 gm of Azilect for two years. There is evidence that Azilect does indeed slow down the progress of the disease. So it's a good idea to be taking it. Even if you  experience no change in your condition, the Azilect may be delaying the progression of the disease.Going beyond 1 gm, however, doesn't seem to offer any advantage.

I did attempt at first to alleviate my symptoms. My dr put me on Mirapex several months ago. I was on it for about a month. I thought that the medication was going to kill me! Not only were there significant side effects, bloating, weight gain, sleepiness, but the improvement in my condition was marginal at best. So I quickly came off it. So I'm back to the Azilect. And holding my own.

You should try to hold off on any other meds until absolutely necessary. Not only do all the meds have various side effects, their ability to help your condition has a definite time  span. After so many years you'll need more of the same medication, and with that the side effects and the wearing off of the medication over time.

The most important thing is find a dr that you are comfortable with and work with him or her. And ask as many questions as you can! There aren't any stupid questions! PD isn't a death sentence. Just remember that PD is a long journey. It's going to be your companion for the rest of your life. As my dr says, don't worry about it. Just live your life normally, and we'll put out the fires as they pop up.

If I can help at all, let me know. Good luck.    





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Avatar_m_tn
Thanks for the information. It's nice to hear from  someone with similar symptoms. I appreciate the advice.
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Avatar_m_tn
I think we have just joined your "club."  My husband (69) is going through the diagnostic process right now (the current date:  April 27, 2010).  He has  a one-sided weakness in his leg, walks stiffly, and says his sense of smell is not what it used to be, among other symptoms.   A general neurologist examined him, ordered bloodwork and a couple of MRI's (brain and neck)--and strongly suspects PD.  

We're struggling to find the right doctors to follow up with.  The PDF recommends going to a neurologist who has special training in movement disorders, like the one you're seeing, Vinny.   We've found several in the New York area, and are now busy making appointments with them.  I guess we'll have to settle on one eventually, and hope that decision will be made clear after we meet with them all.  I'm sure they're all good.  But a lot depends on personality, approach, and just plain chemistry in a situation like this.  We're going to be with this doctor for a long, long time.  And come to think of it, it's probably best if he or she is on the younger side, to outlast us!

Anyway, please keep posting so we can share information and any issues that come up--not to mention it would be great to know there's support out there.

BTW, do you know if there's any system on this site for instant email notification when someone has answered a post?  That would sure help us stay in touch better....

Wendy    
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Avatar_f_tn
I am 58 years old and, after almost 5+ years of symptoms, I am still working with my neurologist to see if what I have is Parkinson's or Parkinson's Plus.  Although my sense of smell was pretty much non-existent starting about 7 or so years ago and I was experiencing killer fatigue and some slight coordination problems, I did not develop a resting tremor until about 3 years ago.  Gait problems followed.  My initial symptoms were very atypical (severe balance problems, followed by some visual problems) and four possibilities were suggested as causes:  1.  brain tumor, 2.  aneurysm,  3.  fatal inflammatory disease of the brain, or 4.  multiple sclerosis.  After going through many tests, including several MRIs with and without contrast (which definitively ruled out MS), bloodwork (which ruled out thyroid and B12 problems), consulting with numerous specialists, including an otolaryngologist who confirmed that there was no problem with my middle or inner ears, a BAER and a VEP, the initial four possibilities were ruled out.  About 2 years ago my neurologist said that what I had was Parkinsonism - either PD or Parkinson's Plus.  About 1 1/2 years ago I started taking 25/100 Sinemet 3 times/day.  I am now taking 25/250 Sinemet 3 times/day plus 25 mg. additional carbidopa for the nausea I was having from the increase in the Sinemet.  My neurologist also started me on .5 mg. of Azilect about a year ago.  I am now taking 1 mg. of Azilect daily.  All considered, I am still doing quite well and my symptoms appear to only be affecting one side so far.  I exercise religiously every morning and still work full time.  I asked my neurologist about seeing a movement disorder specialist but he felt that because my symptoms have been so atypical I would probably get the same response that I have some sort of Parkinsonism, but nothing more definitive than that.  After the experience of the past 5 years, I must confess to a certain amount of diagnostic burnout.  A part of me expects to hear next that this isn't Parkinsonism but something else.  But with an uncle and another family member from the same branch of the family tree with Parkinson's, I'm guessing (hoping) that this turns out to be Parkinson's, rather than Parkinson's Plus.  Has anyone else out there been through a similar lengthy wait for a diagnosis?
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Avatar_m_tn
My diagnosis was fairly quick. I have never heard of Parkinson's Plus. Can you tell me what you know about it?
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Avatar_f_tn
Parkinson's Plus is a term used to refer to a number of conditions that initially resemble Parkinson's disease, but are less likely to respond, if at all, to Parkinson's medications.  Prognosis is poor, with a rapid decline and earlier death than PD.   The following syndromes are included under the umbrella term of Parkinson's Plus:  Multiple System Atrophy (MSA, Shy-Drager), Lewy body dementia, progressive supranuclear palsy, corticobasal degeneration, and PD with ALS.  The Mayo Clinic has information about each of these syndromes at:  http://www.mayoclinic.org/parkinsons-disease/types.html.  I told my neurologist that if he ever tells me that what I have is "plain old PD," I may well be the only patient he has who will be delighted to get that diagnosis.  It sure beats Parkinson's Plus.  One thing this whole experience has taught me - make the most of every day!
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Avatar_m_tn
You all seem like people I can relate to!   I hope you keep posting, so we can get to know one another, share information, and offer support.

First, I need to learn how to better navigate this site.  Is there some way to receive instant email notification when this thread has a new post?  Is that what the "watch list" is?  Or is there some other way to set this up?

Thanks for your help!
Wendy
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Avatar_n_tn
MY DAD IS 65 HIS WIFE LEFT HIM 3 YRS. AGO HE PLAY THE PITY CARD ON US HE SHAKES HIS LEFT HAND I'LL TELL HIM TO QUIT AN HE QUITS HE SAID HE WAS PD CAME HE CONTROL THE SHAKING? HE WOULD HAVE NO BLOOD WORK OR NOTHING HE JUST WANTS PAIN MEDS. PLEASE SOMEONE TELL DOES HE HAVE PD OR IS HE PUTTING ON WANTING ATTENTION HE DRIVING US CRAZY SOMEONE REPLY CRAZY IN SOUTH CAROLINA
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