NEUBRASKA ® Parkinson's Disease
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Parkinson's Disease has four cardinal features: resting tremor, bradykinesia, rigidity and postural instability. Essential tremor is three to twenty times more common than Parkinson's Disease and 50% of patients have a family history of essential tremor. Medications can exaggerate physiological tremor and cause a clinical scenario indistinguishable from essential tremor. A careful and complete history and physical examination needs to be performed on patients with tremor. Early symptoms of Parkinson's Disease may also include poor dexterity, micrographia, reduced voice volume, difficulty getting into or out of cars or chairs, drooling and fatigue.
The tremor of Parkinson's Disease usually begins unilaterally in one hand. It is characterized as being worse "at rest" rather than with "working or use" of the hand. The hand appears to be "pill rolling" or alternating between pronation and supination positions. There are many Parkinson Disease "look alikes" which need to be considered in the differential diagnosis of Parkinson's Disease. Up to 20% of Parkinson's Disease patients are misdiagnosed and, in reality, have one of the following disorders. Neuroleptic induced tremor disorder, Progressive Supranuclear Palsy, Diffuse Lewy Body disease, or multisystem atrophy. Wilson's Disease, a genetic disorder of copper metabolism, may also need to be ruled out by use of MRI, Slit Lamp Exam for Kayser-Fleischer rings, liver biopsy for hepatic copper content, and serum ceruloplasmin levels.
Treatment for Parkinson's Disease is initially pharmacologic but in severe intractable cases, deep brain (subthalamic) electrical stimulation may be successful in controlling tremor. If you have questions regarding Parkinson's Disease, please contact Byron L. Barksdale, M.D.
500 West Leota Street #200
North Platte, Nebraska 69101
Byron L. Barksdale, M.D.
Phone: 308-532-4700
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