The New England Journal of Medicine -- Vol. 341, No. 17
October 21, 1999
The Freezing of Time as a Presenting Symptom of Parkinson's Disease
http://www.nejm.org/content/current.asp
Parkinson's disease, like most chronic conditions, often announces
itself in subtle but telling ways. We recently encountered a 68-year-old
woman whose presenting symptom was that of time standing still.
The woman's husband had given her and their daughter each a self-winding
watch. After the patient had worn the watch on her left wrist for a few
days, it stopped working. She returned the watch to the manufacturer,
who after evaluating it assured her that it was functioning perfectly.
She then exchanged watches with her daughter, but after she had worn her
daughter's watch for a few days, it too stopped. The woman's original
watch, now being worn by her daughter, was working well, so the woman
took that one back. Now the patient wore the watch on her right wrist,
and it kept time properly. Unaccustomed to wearing a watch on her right
wrist, however, she moved it back to her left wrist. Within a few days
the watch stopped working again. Abandoning self-winding watches, the
woman bought a battery-operated watch and gave the matter no further
thought.
Three years later, a tremor at rest developed in her left arm.
Examination revealed mild bradykinesia and rigidity of the arm, with a
resting tremor characteristic of Parkinson's disease. She was treated
with levodopa, and her symptoms improved.
Self-winding watches do not have a battery or an external winding
device. They are powered by an internal ratchet mechanism that relies on
normal motion of the arm to wind an internal spring, and they cease
keeping time if they are motionless. In retrospect, this woman's
self-winding watch probably stopped working when she wore it on her left
wrist because there was a lack of spontaneous activity in that arm; the
decrease in arm movement was far too slight to attract notice but enough
to stop a sensitive watch. This unusual "freezing of time" was the first
symptom of her Parkinson's disease.
Pietro Mazzoni, M.D., Ph.D.
Blair Ford, M.D.
Columbia University
New York, NY 10032
Copyright © 1999 by the Massachusetts Medical Society.
All rights reserved.
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Judith Richards, London, Ontario, Canada
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