Laura,

Thank you very much for the reply.

Answers:

1. The current medications that she is taking, were obviously written down on the forms that were required to be filled out prior to seeing the neuro. She takes pain medication, as needed, calcium pills, and she was taking a pill for incontinence, which is also another PD symptom.

2. I am not sure if the neuro is a movement specialist.

3. I am not sure if the insurance would cover a PET scan. So, a PET scan is a specific brain scan which checks for dopamine levels? To my knowledge, all she has had thus far has been an MRI of the brain, as well as an MRI of the neck. The doctor has also requested to see the MRIs of her back, prior to the surgeries.

4. Interesting, I have never heard of this.

What are the typical steps that neuros take before formulating a firm diagnosis of PD?

PD in the States is largely a clinical diagnosis meaning that the MDS looks for presence of 2 of 3 cardinal signs (bradykinesia, resting tremor, and rigidity). They take into account patient history as well. Once an MRI rules out any other abnormality depending on symptom history, age, etc. they then diagnose. Obviously, we need better diagnostic tools like a blood test or something. The PET scan is routinely used in diagnoses in Europe but not in the US, unsure of Canada. This means to get one, you may have to pay out of pocket, or it sounds like you have an unusual enough onset to have your insurance cover it. The neuro will issue a dopamine challenge by prescribing Sinemet to see if patient has relief from symptoms...this can be the deciding factor in a yes or no diagnosis. In other words, a positive response may likely mean PD.

Laura

Laura,

Thanks for the reply.

It sounds to me that a diagnosis of PD is more or less process of elimination. If all other options are ruled out, it must be PD.

Does anyone know the main difference between PD and PS?

Hi,

You are spot on. Yes, PD is primarily a diagnosis by exclusion.

I think by PS you mean Progressive Supranuclear Palsy or PSP? From what I understand though there is some overlap in symptoms, largely tremor is absent from PSP. Please see the following sites for more info:

http://www.ninds.nih.gov/disorders/p....htm#139803281

Parkinson's Information Network : Differential Diagnosis

Laura,

Thanks for the reply.

When I refer to "PS", I am referring to Parkinsonism, or Parkinson's Syndrome, which to my understanding, is a bit different from PD, or Parkinson's Disease?

Parkinson's Disease is sometimes also called Idiopathic Parkinson's Disease, basically meaning of unknown origin, while PS or parkinsonism mainly refers to a condition on the Parkinson's spectrum that has a known origin, like exposure to particular chemicals, maybe from industrial or work related exposure, or medication, or as a result of TIA's,injury or illness,etc. among several other things. PS is sometimes considered to be either less responsive or non-responsive to dopamine replacement therapies dependent on origin of the condition. There are also Parkinson's plus conditions, of which there are several. They are a range of symptomatically similar conditions that over time differentiate into more recognizable and nameable conditions, that have characteristics of their own. PD itself is by no means clearly defined or definable, and when a diagnosis is unclear it is quite often called atypical, though that is a word that can sometimes be used for PS and P+ type conditions too, making the terminology slightly confusing. All in all IPD is difficult to diagnose, MRI's are used to exclude other conditions, and PET scans are used to firm up an IPD diagnosis or rule it out. Even so a diagnosis is usually arrived at through a combination of scans and long term observation, unless there are unequivocal signs that PD or another parkinson's type condition is present, which does sometimes happen!

Many of us have learned through experience that diagnosis and treatment can take time to get 'right', and some of us live with a 'possible' or 'probable' diagnosis. If your mother responds well to the medication (sinemet) she has been prescribed it is likely, though not definite, that she has PD.

While there is a process of elimination that goes on, it is unlikely that 'all other options' can be excluded completely at such an early stage, so the aim will be to get as close as possible and find a treatment regime that gives the best possible quality of life.

Hope this helps
Lindy

Hi Lindy,

Thank you very much for your reply.

The information you provided is very concrete and makes complete sense.

It may sound odd, but the profession I work in is of a technical nature, and sometimes requires a great deal of equipment troublehsooting. As I have been reading about PD and the steps required to form a diagnosis, I often relate such a process to the technical troublehshooting process I often find myself performing as part of my job. I too perform tasks that "rule out" potential problems, which puts me one step closer to determining the cause and solution to particular problems. It sure sounds like forming a diagnosis of PD or PS is more-or-less a "troublehshooting" process and includes a plethora of "ruling out". Unfortunately with PD or PS we are working with people's health and lives, instead of equipment.

After I read your post, I thought back to some of the discussion points our neuro was speaking in regards to, and they are really starting to make sense. Since her symptoms are pointing in the direction of PD, the next step, including an analysis of the MRI, is to start taking the Carbidopa/Levodopa to see how my mother reacts. If her condition "gets better", we are one step closer to a PD diagnosis. If her symptoms remain the same, we have decreased the probability of a PD diagnosis, and we start looking at other potential issues.

I must say that after joining this forum, in addition to other readings, I have faith in the neuro that we are seeing. Over the years I have come to lose trust in the integrity of certain doctors, but in this case, I am trying to remain optimistic.

Whatever the case ends up being, I can only hope that the medications and treatments available will help in providing her the ability to live the life that she is used to living.

Thanks again for the reply and support.

Matthew