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ANA: Physicians Need to Improve Their Accuracy in Detecting Parkinson's Disease By Jill Stein Special to DG News NEW YORK, NY -- October 16, 2002 -- Parkinson’s disease (PD) is often initially misdiagnosed, researchers reported here October 14 at the 127th Annual Meeting of the American Neurological Association (ANA). Dr. Stephen Reich, with Johns Hopkins Medical Institutions, in Baltimore, Maryland, United States, and co-workers interviewed 177 consecutive PD patients to determine how the PD diagnosis was established. At the initial encounter, 32 percent of patients were diagnosed correctly or the presence of PD was suspected, an incorrect diagnosis was made in 29 percent of patients, and no diagnosis was made in 39 percent. A primary care practitioner was the first medical contact in 130 (73.4 percent) patients, a neurologist in 20 (11.3 percent) patients, and another specialty physician (for example, an orthopedic surgeon) in 27 (15.3 percent). Almost all patients had cranial imaging -- a computed tomography (CT) scan in 14 percent of patients and magnetic resonance imaging in 70 percent - - which was performed in many cases even when PD was diagnosed. In no instance was a clinically relevant abnormality discovered, and imaging was more likely to be misleading. Spinal CT scans were performed in about 5 percent and spinal MRIs in about 24 percent of patients. Additional testing included elecromyelography in 22 percent of patients, electroencephalogram in 11 percent, carotid ultrasound in 6 percent, lumbar puncture in 5 percent, and evoked potentials in 2 percent. Only age at onset and seeing a neurologist were strong positive and negative predictors, respectively, of diagnostic accuracy. Dr. Reich said that there are three main reasons for this finding. First, the heterogeneity of PD is underappreciated. This is especially true for young onset PD, which accounts for roughly 5 percent of all cases. A second reason is that there is a lack of awareness that PD may present with pain and other sensory symptoms, mimicking a musculoskeletal disorder. Another reason for the low diagnosis rate is a general unfamiliarity with the symptoms and signs of early PD among neurologists as well as primary care doctors. During residency training, which typically de-emphasises outpatient medicine, only more advanced cases of PD are encountered on in- patient services, where the condition is fully developed and obvious, whereas trainees have fewer opportunities to encounter early PD. Another diagnostic hurdle is that early PD can easily be mistaken for essential tremor, which in this series occurred in 15 percent of initial medical encounters. Based on these findings, Dr. Reich and colleagues concluded that more effort is needed to educate doctors about the heterogeneity and early features of PD. SOURCE: Doctors Guide - Global Edition - DG News http://www.pslgroup.com/dg/22067e.htm * * * ---------------------------------------------------------------------- To sign-off Parkinsn send a message to: mailto:[log in to unmask] In the body of the message put: signoff parkinsn