Saturday, July 30, 2022

Shaking Disease Not Parkinson’s

Which Test Can Be Done When The Diagnosis Is In Doubt

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I request a small set of tests on almost all patients I diagnose with Parkinsons. These detect some mimics of Parkinsons disease.

Some doctors dont request all these tests. And for a good reason.

The diagnosis of Parkinsons mimics is primarily based on a careful history and examination. Even in my practice, these tests change the diagnosis only in a minority of patients.

I like the additional confirmation provided by these tests. They also have other benefits. For example, they help me determine the proper dosages of medications like Amantadine.

Simple tests to detect Parkinsons Mimics
1. MRI-Brain with size measurements of brain parts called the midbrain and pons. I usually also request a unique picture called SWI, which shows iron inside the brain.

2. Blood tests:

  • HIV
  • VDRL
  • But when the diagnosis s really in doubt, there is another brain scan that can be done.

    A Trodat scan. Or even better an F-DOPA scan. Both these scans measure dopamine activity inside the brain.

    You can read more about Trodat & F-DOPA scans by clicking here.

    These scans are not perfect. Let me tell you why very quickly:

    In Parkinsons disease, dopamine activity inside the brain is deficient. This deficiency produces an abnormal scan. If the Trodat/F-DOPA scan is normal, it is unlikely that you have Parkinsons disease.

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    What Are The Results

    Successful DBS is related to 1) appropriate patient selection, 2) appropriate selection of the brain area for stimulation, 3) precise positioning of the electrode during surgery, and 4) experienced programming and medication management. DBS for essential tremor may significantly reduce hand tremor in 60% to 90% of patients and may improve head and voice tremor.

    Patients report other benefits of DBS. For example, better sleep, more involvement in physical activity, and improved quality of life.

    What Is The Difference Between Essential Tremor Andparkinson’s

    The exact cause of essential tremor is unknown while Parkinson’sdisease is better understood.

    In Parkinson’s disease, neurons located in the part of the brain thatcontrols movement become impaired or die. These neurons usually produce achemical called dopamine which enables regular body movements. When the neuronscan’t produce necessary levels of dopamine, tremors can occur, along withrigidity of limbs and decreased coordination.

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    Painful Symptoms Of Parkinsons Disease

    Pain can sometimes be an early symptom of PD. For example, a person may complain of a painful shoulder and be diagnosed with an orthopedic condition such as a frozen shoulder, only to develop a rest tremor on that side at a later point. The painful shoulder was in fact not a frozen shoulder after all, but rather pain due to the rigidity of PD. Now of course, sometimes a frozen shoulder is really just a frozen shoulder, so theres no need to jump to conclusions when you are experiencing pain. Not every ache and pain is a sign of PD, but it is important for you to educate yourself, be aware of the possible connections, and be proactive about seeking medical attention for any notable pain you are experiencing.

    If you have PD and develop pain, it is important to first bring this to the attention of your doctor. The pain may be related to your PD, or the pain may be due to a common problem such as arthritis which is exacerbated by your PD. However, in some cases, it may be a symptom of a more serious medical problem. So do not assume that the pain is related to your PD before getting an appropriate medical workup.

    Who Gets Parkinsons Disease

    Parkinsons Disease  WIINS

    About 1 million people in the United States have Parkinsons disease, and both men and women can get it. Symptoms usually appear when someone is older than 50 and it becomes more common as people get older.

    Many people wonder if youre more likely to get Parkinsons disease if you have a relative who has it. Although the role that heredity plays isnt completely understood, we do know that if a close relative like a parent, brother, or sister has Parkinsons, there is a greater chance of developing the disease. But Parkinsons disease is not contagious. You cant get it by simply being around someone who has it.

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    What Can You Do If You Have Pd

    • Work with your doctor to create a plan to stay healthy. This might include the following:
    • A referral to a neurologist, a doctor who specializes in the brain
    • Care from an occupational therapist, physical therapist or speech therapist
    • Meeting with a medical social worker to talk about how Parkinsons will affect your life
  • Start a regular exercise program to delay further symptoms.
  • Talk with family and friends who can provide you with the support you need.
  • For more information, visit our Treatment page.

    Page reviewed by Dr. Chauncey Spears, Movement Disorders Fellow at the University of Florida, a Parkinsons Foundation Center of Excellence.

    What Is A Resting Tremor

    A Parkinsons tremor differs from most other types of tremor because it is a resting tremor. It happens most often when a body part is relaxed rather than in motion. For a Parkinsons patient, a hand may quiver when resting in a lap or when holding a utensil to the mouth while eating.

    Most tremors are action tremors where the shaking happens when a person moves their muscles. These may occur when holding arms outstretched, holding a heavy item in one position, or reaching slowly and purposefully toward an object.

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    Medical Treatment Of Parkinsons Disease

    Levodopa/carbidopa is the most effective medication in terms of improving the motor symptoms associated with Parkinsons disease. However due to the frequent, and sometimes serious side effects of this drug, neurologists prefer trying other medications first. Unfortunately, the medications available are not as good as levodopa/carbidopa in the control of the motor symptoms and also have some side effects that limit their use.

    Selegiline a medication that does not have any major effects on the motor symptoms, might be the only medication with some protective effect of the nerve cells, but this is not yet well proven. The other medications are only used to treat the symptoms.

    Tremors Not Always Caused By Parkinsons

    Deep Brain Stimulation for Parkinson’s Disease

    While researching Parkinsons Awareness Month, I came across a question posted on Providence Health Services website that took me down a bunny trail. The patient asked, Is the shaking in my left hand, which was diagnosed as an essential tremor related to Parkinsons disease?

    Dr. Kiren Kresa-Reahl, a neurologist with Providence, replied. Theres a common misconception that everything that shakes is Parkinsons disease, but thats not true. Both essential tremor and Parkinsons cause hand tremors, but they are completely different disorders. Having an essential tremor does not mean that you have or will get Parkinsons disease.

    Following that line of thinking, not all people with Parkinsons have a tremor, either. So that led me to follow the rabbit and to start treading about tremors and what possibly could be the cause and certainly the effect.

    Tremors are classified into two main categories, resting, and action. The resting tremor is most often seen in people with Parkinsons. It occurs when the muscle is relaxed. An action tremor occurs with the voluntary movement of a muscle.

    The National Institute of Neurological Disorders and Stroke drills the description of action tremors down to more classifications, many of which overlap. Postural tremor occurs when a person maintains a position against gravity, such as hold the arms outstretched. Kinetic tremor is associated with any voluntary movement, such as moving the wrists up and down or closing and opening the eyes.

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    What To Expect From Diagnosis

    Theres no single test for Parkinsons, so it can take some time to reach the diagnosis.

    Your doctor will likely refer you to a neurologist, who will review your symptoms and perform a physical examination. Tell your doctor about all the medications you take. Some of these symptoms could be side effects of those drugs.

    Your doctor will also want to check for other conditions that cause similar symptoms.

    Diagnostic testing will be based on your symptoms and neurologic workup and may include:

    • blood tests

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    Conflict Of Interest Statement

    Vanderbilt University receives income from grants and contracts with Allergan, Ipsen, Lundbeck, Merz, Medtronic, and USWorldMeds for research or educational programs led by DC. DC receives income from Allergan, Alliance for Patient Access, Ipsen, Medtronic, and Revance for consulting services.

    The remaining authors declare that the research was conducted in the absence of any commercial or financial relationships that could be construed as a potential conflict of interest.

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    What Lifestyle Changes Can I Make To Ease Parkinsons Symptoms

    Exercise: Exercise helps improve muscle strength, balance, coordination, flexibility, and tremor. It is also strongly believed to improve memory, thinking and reduce the risk of falls and decrease anxiety and depression. One study in persons with Parkinsons disease showed that 2.5 hours of exercise per week resulted in improved ability to move and a slower decline in quality of life compared to those who didnt exercise or didnt start until later in the course of their disease. Some exercises to consider include strengthening or resistance training, stretching exercises or aerobics . All types of exercise are helpful.

    Eat a healthy, balanced diet: This is not only good for your general health but can ease some of the non-movement related symptoms of Parkinsons, such as constipation. Eating foods high in fiber in particular can relieve constipation. The Mediterranean diet is one example of a healthy diet.

    Preventing falls and maintaining balance: Falls are a frequent complication of Parkinsons. While you can do many things to reduce your risk of falling, the two most important are: 1) to work with your doctor to ensure that your treatments whether medicines or deep brain stimulation are optimal and 2) to consult with a physical therapist who can assess your walking and balance. The physical therapist is the expert when it comes to recommending assistive devices or exercise to improve safety and preventing falls.

    How Is Tremor Classified

    Parkinsons Disease: Symptoms, Diagnosis and Treatment  Healthsoul

    Tremor can be classified into two main categories:

    Resting tremor occurs when the muscle is relaxed, such as when the hands are resting on the lap. With this disorder, a persons hands, arms, or legs may shake even when they are at rest. Often, the tremor only affects the hand or fingers. This type of tremor is often seen in people with Parkinsons disease and is called a pillrolling tremor because the circular finger and hand movements resemble rolling of small objects or pills in the hand.

    Action tremor occurs with the voluntary movement of a muscle. Most types of tremor are considered action tremor. There are several sub-classifications of action tremor, many of which overlap.

    • Postural tremor occurs when a person maintains a position against gravity, such as holding the arms outstretched.
    • Kinetic tremor is associated with any voluntary movement, such as moving the wrists up and down or closing and opening the eyes.
    • Intention tremor is produced with purposeful movement toward a target, such as lifting a finger to touch the nose. Typically the tremor will become worse as an individual gets closer to their target.
    • Task-specific tremor only appears when performing highly-skilled, goal-oriented tasks such as handwriting or speaking.
    • Isometric tremor occurs during a voluntary muscle contraction that is not accompanied by any movement such as holding a heavy book or a dumbbell in the same position.

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    Pain Is A Common But Overlooked Problem In Parkinsons Disease

    Pain is an often overlooked non-motor symptom of Parkinsons disease . Studies show that between 40-80% of people with PD report pain, which is likely why it is often suggested as a topic for this blog.

    One of the reasons why the topic of pain and PD is difficult to address is that it is sometimes tough to discern whether a particular pain is due to PD or not. Chronic pain is such a common symptom among the general population, and people with PD are not immune to common problems as well. However, there are aspects of PD that may exacerbate the pain experienced from a common problem. In addition, there are particular types of pain that may be unique to people with PD.

    Tremors Definition And Facts

    Tremors are non-intentional rhythmic movements of a body part, which are the result of alternating or irregular synchronous contractions of muscles that have an opposite effect on a joint. For example, muscles that, when contracted, result in flexion of the wrist are stimulated synchronously with muscles that result in extension of the wrist. The result is a rhythmic flexion and extension of the wrist.

    Facts

    • This phenomenon can happen in any part of the body including: head, neck, face, thumb, or arm.
    • It is this rhythmic quality that defines and distinguishes tremors from any other abnormal movements.
    • Two tremors classes including: physiologic and pathologic

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    Why Is My Cats Head Trembling

    Though occasional head shaking is normal in cats, continuous head shaking or trembling unusually may indicate that something is wrong with your cat. It can be due to ear infection, allergies, or inflammatory skin disease.

    The head trembling may also occur when your cat has some neurological disorders or myopathy. However, it can be a sign of Feline Infectious Peritonitis or severe oral problems.

    If you see your cat trembling its head abnormally and losing its balance, you must consult your vet immediately for proper diagnosis and treatment.

    Treatments For Essential Tremor

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    According to Harvard.edu, there are several actions that can be taken to help manage your essential tremor and minimize how they impact your daily life. First, lets cover treatment options:

  • Oral Medications: Propranolol and primidone are considered to be the most effective treatments for essential tremor, reducing tremors as much as 50%. Propranolol is a beta-blocker and primidone is an anti-seizure medication.
  • Surgical Treatment: In cases where essential tremor does not respond to medication, surgery may be recommended. There are invasive techniques, such as deep brain stimulation, that can be used to help reduce tremors. However, brain surgery is not without its serious risks.
  • Non-Invasive Therapy with Cala Trio: Cala Trio is a wrist-worn non-invasive therapy device that is calibrated to relieve hand tremors. It works by delivering surface stimulation at your wrist, which is believed to disrupt the central tremor network in your brain. In one clinical study, 64% of patients reported tremor relief and the average reported time was 94 minutes. Available only by prescription, the Cala Trio wrist-worn device provides on-demand tremor relief.
  • As each patient is different, you and your doctor will need to decide what the best course of action is for you. You must weigh the pros and cons of each treatment option based on your lifestyle and how you think theyll impact your quality of life.

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    How Does Essential Tremor Develop

    Essential tremor symptoms often first appear in a person’s 40s, when delicate movements such as threading a needle become difficult. But it’s usually not until people reach their 50s or 60s that the tremor becomes troublesome for example, making it difficult to use a fork, drink from a cup, or write a letter. Essential tremor progresses slowly. Though essential tremor may eventually affect the voice and head, many people find that their symptoms don’t progress beyond mild hand and arm tremor. Tremors are usually absent during sleep.

    We don’t know the precise cause of essential tremor. Some experts believe that the problem lies in the cerebellum or its connections with the brainstem, which lies at the base of the brain. Essential tremor is a heritable condition. If you have essential tremor, your children will have a 50% chance of developing it as well.

    The Tremors Of Parkinsons Disease

    The distinction between these different tremors is not always visible to the naked eye. For example, resting tremor can re-emerge during postural holding, making it difficult to clinically distinguish it from essential tremor. This distinction can be made by focusing on the delay between adopting a posture and the emergence of tremor: in essential tremor there is no delay, while Parkinsons disease resting tremor re-emerges after a few seconds . Since the frequency of re-emergent and resting tremor can be similar, it has been hypothesized that both tremors share a similar pathophysiological mechanism. One interesting patient with Parkinsons disease had no resting tremor, but a marked 36Hz postural tremor that occurred after a delay of 24s following postural holding , thus resembling re-emergent tremor. Such observations point to heterogeneity in the circumstances under which the classical Parkinsons disease resting tremor occurs.

    In the following sections, we will mainly focus on the classic resting tremor in Parkinsons disease. We will first describe the clinical and cerebral differences between patients with tremor-dominant and non-tremor Parkinsons disease. Then we will detail how these differences may inform us about the causes and consequences of Parkinsons disease resting tremor.

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    Hand And Wrist Exercises

    Your healthcare provider may refer you to a physical or occupational therapist for treatment or recommend exercises you can do at home.

    Squeezing a stress ball or hand grip for two to 10 seconds, releasing, and repeating 10 times on each hand can be an easy exercise to incorporate into your day.

    Rotating the wrists in a circular motion can keep tendons and ligaments flexible. Moving the hands with intention can keep synovial fluid from building up, which prevents or reduces tremors.

    Curling a light hand weight with arms resting on a table and your palms facing up can also strengthen and fine-tune your muscle control.

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