“It is important to remember that the doctor is not God. If something doesn’t work right or doesn’t feel right for you, get a second opinion.”
—JIM N., PWP
There are several look-alikes to Parkinson’s that may not be officially labeled as atypical parkinsonian or Parkinson’s plus disorders. Some people who initially think they have Parkinson’s may have one of these instead.
DRD is a type of dystonia (sustained muscle contractions causing abnormal postures) that usually begins in childhood. People with this disease develop unusual postures of the head and neck, arms, and legs. Interestingly, more than one-third of people with DRD have a family history of PD. DRD responds well to long-term use of levodopa and is typically not a progressive disorder like PD.
ET is a common neurological condition (at least eight times more common than PD) that usually onsets during middle age but may occur at any time during a person’s life span.23 ET may progress slowly over years. It is usually asymmetric and is most noticeable when the hands are moving. In PD, tremors appear when the hand is at rest. With ET, tremors are more rapid than the resting tremors of PD and can involve any part of the arm, although they most commonly occur in the hands.
ET may involve the head, jaw, or voice, and less commonly the legs. People with ET usually have a family history of tremor and may have mild parkinsonism, which can be confused with PD.
Parkinsonian tremor and essential tremor generally respond to different drugs; therefore getting the correct diagnosis is important. A small number of people with ET may develop PD. Read more about the differences between ET and PD in chapter 8.
NPH is a condition in which the person has difficulty walking and experiences mental changes (like forgetfulness) and bladder problems. It is caused by an enlargement of the fluid ventricles (cavities) in the brain, which then compress the parts of the brain that affect thinking and walking.
There is no known cause of NPH, but it may be helped by having a shunt placed in the brain to drain off excess fluid.
Huntington’s is an inherited disease that usually begins in early midlife. People with this disease have involuntary movements (dys-kinesias, chorea) that are associated with changes in behavior, personality, and mood.
The chorea (which resembles the involuntary movements caused by levodopa) may occur before, during, or after the mental changes. It is spontaneous, involuntary, and not caused by medications.
Once the disease is fully developed, it is easily distinguished from PD. However, the symptoms of a childhood form of Huntington’s disease may resemble PD. Levodopa usually worsens the symptoms of Huntington’s disease.
Wilson’s disease is a rare inherited disorder that strikes people under the age of 40 and involves damage to the brain and liver. Early diagnosis is important because treatment prevents further damage.
Tumors of the brain that are close to the substantia nigra or the striatum may put pressure on these parts of the brain. This local pressure may then result in the appearance of symptoms that look like PD.
A CT (CAT) or MRI scan of the brain will exclude the possibility of a brain tumor as the cause of the parkinsonian symptoms.
Because Parkinson’s can often be misdiagnosed, it’s very important that you seek out a neurologist or movement disorders specialist for your diagnosis. They are your best bet for sorting out whether you have PD or something else. Also, remember that although it’s an option to get a second opinion during the diagnosis phase, be wary of “doctor shopping” as your disease progresses. You’ll want to stick with one doctor as much as you can in order to get the best treatment over time.