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Is it really PD? (1 Nov 96) Although response to Sinemet is not a 100% sure sign of PD, it's a pretty good rule of thumb and should not be ignored. Despite dilig- ent searching, a more positive indicator still eludes us. The best definition of PD that I know is, shortage of dopamine in the basal ganglia, hard to define and even harder to measure in a living patient. No one is sure exactly why dumping in more dopamine via the bloodstream works against PD, but it certainly does. There are several mimics of PD such as MSA, PSP, SND, DLBD, OPCA, (and hydro- cephalus, recently mentioned here) that may confuse diagnosis AT FIRST, and some do respond (briefly) to dopamine replacement by Sinemet. But the error should be evident soon to a neuro having the right background in movement disorders, or in some cases immed- iately. Maybe the relatively rare occurrence of the mimics is a factor. I can't speak as an MD, but it seems to me that hydro- cephalus, where prompt intervention is vital, shouldn't be that hard to tell from PD. As for the other PD mimics, there isn't an effective treatment anyway, and even if dopamine replacement is only a temporary palliative, I should think it's better than nothing. So the strategy, lacking better information, of trying dopamine first may sometimes delay accurate diagnosis, but it should usually prove to be a good bet. Cheers, Joe J. R. Bruman (818) 789-3694 3527 Cody Road Sherman Oaks CA 91403