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Parkinsonism

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My Dr. told me I didn't have Parkinson's disease, but I had Parkinsonism. I take generic Requip(3mg, 3x day) & generic Neurotonin (Gabapentin) 100mg 3x day. This was increased to 200mg as I have a lot of trouble with numb feet & legs & use a walker when necessary. I don't have the facial expression of PD. I don't have stiffnes or freezing. I have tremors in my hands & arms when I am carrying - say- a cup of coffee or something. No tremors at rest. my eyelids droop & I have trouble passing urine but also need protective panties. Also constipation. I have Mitral Valve Prolapse which causes me to faint or almost faint if I stand up too fast. My blood pressure is low, I sleep propped up with a bed-wedge. Also heart rythm problems, I take a Beta blocker. I am in my 70's & retired.

 

What is the defination of Parkinsonism? Is it just a catch phrase for symptoms that occur with pd but not enough for a definitive diagnoses? Will this turn into "true" pd? The original diagnosis was 3 years ago & my legs keep getting worse, but the rest of the symptoms are the same. So far my mental status is good, but I try not to drive .

 

Thanks for your time

Anon.

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You ask an important question, therefore I am making this also the Post of the Week!

 

Parkinsonism simply refers to a person who has symptoms that look like Parkinson’s disease, but after careful scrutiny they are found not to have regular idiopathic Parkinson’s disease. The symptoms in many cases may include the same motor and non-motor manifestations of Parkinson’s disease.

 

Parkinsonism usually does not respond well to dopamine or to other medications commonly used to treat Parkinson’s disease, and your doctor should perform an on/off clinical examination with a tool called the Unified Parkinson’s Disease Rating Scale to observe whether there is an adequate response to dopaminergic medications (usually approximately 30% or more in Parkinson’s disease).

 

There are several Parkinsonian syndromes which have distinctive characteristics when compared to regular garden variety Parkinson’s disease. Some illustrative examples include (note not all of the below features need to be present for a diagnosis):

 

Lewy Body Disease- Parkinson’s symptoms plus hallucinations and thinking problems which occur within the first few years of diagnosis.

 

Corticobasal Degeneration- Parkinson’s symptoms along with problems with skilled movements (apraxia), a misbehaving limb (alien limb), sensory loss, myoclonus (sudden-lightening like movements), and possibly dementia.

 

Mutiple System Atrophy- Cerebellar Type- Parkinson’s symptoms plus problems walking and problems with coordination (also called Olivopontocerebellar Degeneration or OPCA).

Multiple System Atrophy- Autonomic Type- Parkinson’s symptoms plus problems with autonomic dysfunction (early erectile or sexual dysfunction, dizziness when standing up, problems with digestion and/or constipation (also referred to sometimes as Shy-Drager syndrome).

Multiple System Atrophy- Striatonigral Degeneration Type- severe Parkinson’s symptoms but largely unresponsive to dopaminergic therapy.

 

Progressive Supranuclear Palsy- severe Parkinson’s symptoms, plus early falling, dementia, and problems moving the eyes particularly in the up and down directions.

 

Vascular Parkinsonism- usually presents with shuffling feet (some people call it lower body Parkinsonism) and it is usually caused by small strokes with or without other Parkinson’s symptoms.

 

*We like to conservatively observe regular cases of Parkinson’s disease for five or more years before making a definitive diagnosis because in some cases Parkinsonism or Parkinson’s plus can be levodopa responsive many years into the illness

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