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Invalidation of Parkinson's disease diagnosis after years of follow-up based on clinical, radiological and neurophysiological examination.

Abstract：

INTRODUCTION:Diagnosis of Parkinson's disease (PD) is mainly based on clinical features. Accurate neurological examination is required but dopamine transporter (DaT) single photon emission computed tomography (SPECT) could be perfomed to support the diagnosis in ambiguous cases. The aim of this work is to describe the characteristics of patients with a prolonged PD misdiagnosis. METHODS:We collected data from 24 patients initially diagnosed with PD who had an atypical long-term evolution. We analyzed demographic and clinical characteristics and antiparkinsonian drugs medication. Brain MRI, DaT-SPECT and/or accelerometry/electromyography (EMG) recording were performed in a subgroup of patients. We analyzed the causes of erroneous PD diagnosis as well as the final diagnoses. RESULTS:Mean age at PD diagnosis was 60.4 ± 14.8 years. Symptoms at onset were rest tremor (n = 19), gait instability (n = 7) and micrographia (n = 4). Mean duration before diagnosis correction was 8.4 ± 5.3 years. All patients were treated by antiparkinsonian drugs with a mean daily levodopa equivalent dose (LED) of 508.1 ± 528.4 mg. All 18 patients who underwent DaT-SPECT had a normal result. The most frequent final diagnoses were essential tremor (n = 11) and functional movement disorders (n = 9). CONCLUSION:Cases that have been initially diagnosed as PD and then progress in an atypical long-duration fashion may have been misdiagnosed. Absence of genuine bradykinesia, non-sustained response to antiparkinsonian drugs, or absence of levodopa-related side effects should prompt the clinician to reappraise the diagnosis and to consider performing a DaT-SPECT.

journal_name

J Neurol Sci

journal_title

Journal of the neurological sciences

authors

Coarelli G,Garcin B,Roze E,Vidailhet M,Degos B

doi

10.1016/j.jns.2019.116454

subject

Has Abstract

pub_date

2019-11-15 00:00:00

pages

116454

eissn

0022-510X

issn

1878-5883

pii

S0022-510X(19)30386-7

journal_volume

406

pub_type

杂志文章

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