HOW OFTEN IS PARKINSON’S MISDIAGNOSED?

References made by Brain & Spine and NCBI/NIH

A combination article

According to an article published by Brain & Spine October 16, 2018...

You may first notice a tremor in your hands. Or that you walk a bit unsteadily. Or that you feel stiff and slow.

    If you check the internet, you may conclude you have Parkinson’s disease. Even your family doctor might diagnosis this chronic and progressive neurological disease.

    But other conditions closely mimic Parkinson’s. And because they are treated differently, it’s important to get a correct diagnosis as soon as possible.

    “For a couple of conditions, the prognosis, treatment and advice are totally different from Parkinson’s,” says Hubert Fernandez, MD, Director of the Center for Neurological Restoration.

    A neurologist is your best bet for sorting out whether you have Parkinson’s or something else, he says. Treatment decisions made early in the illness can affect your long-term success in managing the condition.

    What looks like Parkinson’s, but isn’t? Dr. Fernandez describes two main Parkinson’s mimics:

Essential Tremor — Also known as benign essential tremor or familial tremor, this movement disorder causes brief, uncontrollable shaking.

    It most often affects your hands, but can also affect your head and neck, larynx (voice box) and other areas. In rare cases, it affects your lower body as well.

    But one clue can help distinguish essential tremor from Parkinson’s. “This is not an absolute rule, but if shaking occurs at rest, it often is Parkinson’s. And if shaking occurs in action, such as when you’re writing or eating, it is essential tremor,” Dr. Fernandez says.

    About half of those with essential tremor have a family history of the condition.

    Unlike Parkinson’s, essential tremor is generally not perceived as a progressive disorder, and, if mild, may not require treatment.

    Doctors can prescribe medications to reduce shaking, but they are not the same drugs used to treat Parkinson’s, he says.

Drug-induced Parkinson’s — Along with shaking, this condition may cause many symptoms similar to Parkinson’s disease, including stiffness, slow movement, a decrease in facial expression and a change in speech.

    As the name suggests, taking certain drugs, most commonly antipsychotics and mood stabilizers, can trigger this condition. How long it takes to develop can vary greatly, depending on which drug you’re taking, how long you take it and the dosage.

    Your doctor likely will treat drug-induced Parkinson’s by adjusting your medication.

    “We always work with a psychiatrist as we taper off and try new drugs,” Dr. Fernandez says. “We want to do what is best for the body and what is best for the brain.”

    Other neurological disorders fall into a category known as Parkinson’s plus syndromes, which can cause similar symptoms. Doctors typically treat these syndromes the same way they treat Parkinson’s disease. “The medications we prescribe are about the same as what we use for Parkinson’s, but we expect different outcomes,” he says. “However, a diagnosis of essential tremor or drug-induced Parkinson’s would call for a totally different treatment.”

    The right diagnosis can save time (and money) because the symptoms of Parkinson’s vary and often overlap other conditions, it is misdiagnosed up to 30 percent of the time, Dr. Fernandez says. Misdiagnosis is even more common in the early stages.

    Patients who don’t know where to turn may make appointments with a rheumatologist, or an orthopaedic or heart specialist, and undergo MRIs, EMGs and other expensive tests.

    But only a neurologist can distinguish Parkinson’s from essential tremor, drug-induced Parkinson’s and Parkinson’s plus syndromes, he says.

    “If patients come to us with typical signs of Parkinson’s, we don’t need to order expensive tests,” he says.

    Instead, neurologists base their diagnosis on a detailed patient exam and medical history, along with other information from the patient, family members or caregivers.

    “That’s all stirred into the pot,” he says. “Sometimes we can diagnose Parkinson’s with one visit. Other times, several follow-up visits are necessary.”

HOWEVEVER MANY NEUROLOGISTS HAVE NO UNDERSTANDING OF TMD – TEMPOROMANDIBULAR JOINT DISORDER

According to an article published by NCBI/NIH January 6, 2011...

Neurologic disorders, including dystonias, and Parkinson’s disease, are common in aging adults. Treatments vary, but evidence-based and comparative effectiveness analysis has not yielded systematically reviewed best available evidence of satisfactory interventions. The auriculotemporal (AT) nerve, a branch of the mandibular nerve, innervates the temporomandibular joint, and courses to the tympanic membrane and anterior cochlear surface and neighboring tissues. AT fibers project to the sympathetic otic ganglion. Clenching, grinding, trauma, bone loss and stress can change the jaw bite, and decrease its vertical dimension. Subsequent irritation and compression of the AT nerve can occur, with associated parasthesia, pain and discomfort. Symptoms can be local and specific (e.g., TMD), as well as varied and systemic (e.g., neurologic, dystonic and neuro-muscular disorders, including tremors, muscle spasms leading to impaired and awkward positional control of the head, hands, other extremities, speech impairment, incontinence, impaired sleep, associated depressive symptomatology).

    Diagnosis of TMD, for example by comparing the temporomandibular joint space and condylar position by meticulous scanning of tomographic or cone beam projections in patients with anterior disc displacement, is challenging. Managing patients with TMD is also a complex endeavor.

    We have observed that intervention, aimed at changing the maxillomandibular occlusal relationship by changing the vertical dimension of the patient’s jaw bite, relieves AT compression and associated irritation, and leads to immediate and sustained symptomatic improvement clinically. A profile of certain proteomic biomarkers of pain and of temporomandibular joint dysfunction may be assembled to assess and detect the prognostic changes in TMD following intervention directed specifically at relieving the irritation and compression of the AT nerve.

Editor’s Note: Very few dentists have an understanding of the neurologic relationship involved in TMD. You may find one of these highly trained and credentialed dentists in the Wellness Village  at  ParkinsonsResource.org/the-wellness-village/business-types/dentist/