Early Signs of Parkinson's Disease: Symptoms and Diagnosis

Early-stage Parkinson's disease?

Hello Dr.
Lan: I have noticed that my hands have been trembling involuntarily since last year.
Initially, I felt that both hands were shaking, but the tremors were very slight.
However, since this had never happened before, I became quite anxious.
In September of last year, I visited an endocrinologist for blood tests to check for thyroid issues and underwent an ultrasound, but all results were normal.

In September 2014, while taking a shower, I suddenly experienced stiffness in my neck and a feeling of pressure in my scalp; this was one of the most painful moments of my life.
The pain lasted for about three days, and when I visited a neurologist, no tests were performed.
The doctor suggested it might be due to poor blood circulation in the neck.
After my family helped me with massages, the headache alleviated the next day.

Since that day, I have noticed some changes in my body.
My left leg feels strange when I walk; it doesn’t drag, but I feel some weakness in it.
In May of last year, I underwent an EEG at the Tri-Service General Hospital, which also came back normal.
However, I still feel some weakness in my left leg and occasionally experience sudden dizziness, which feels like orthostatic hypotension.

In September of last year, I started feeling sudden movements in my body whether lying down, sitting, or standing; these sensations were very brief, lasting only 1-2 seconds, but I was the only one who could perceive them.
Due to my hand tremors, I researched online and found that most information is related to Parkinson's disease, which has made me quite worried.

Three days ago, I noticed that my left hand trembles while at rest, but it’s not like the action of rolling a pill; rather, my entire left hand shakes.
Additionally, my left eye keeps twitching, and both sides of my cheeks feel slightly stiff.
I would like to ask Dr.
Lan if my symptoms resemble early signs of Parkinson's disease.
What tests can be done to rule out the possibility of Parkinson's disease? I understand that the likelihood of developing Parkinson's at my age is low, but there are still cases.
Therefore, I would like to ask Dr.
Lan, if it were Parkinson's disease and the response to dopamine medication is poor, could that indicate it is not Parkinson's disease?

Alon, 20~29 year old female. Ask Date: 2016/04/28

Dr. Lan Shengxing reply Neurology

Dear Aaron, the likelihood of developing Parkinson's disease at your age is low, and the symptoms you described do not resemble the early signs of Parkinson's disease.
Additionally, you did not mention any reactions after taking medication.
I personally recommend that you consult a neurologist who specializes in movement disorders.

Reply Date: 2016/04/28

More Info

Parkinson's disease (PD) is a progressive neurodegenerative disorder that primarily affects movement. It is characterized by a range of motor and non-motor symptoms, which can significantly impact the quality of life of those affected. Understanding the early signs of Parkinson's disease is crucial for timely diagnosis and management.

Early Signs and Symptoms
The early symptoms of Parkinson's disease can be subtle and may vary from person to person. Common early signs include:
1. Tremors: Often starting in one hand, tremors may occur at rest and can be described as a "resting tremor." This is one of the hallmark symptoms of PD.

2. Bradykinesia: This refers to slowness of movement. Individuals may notice that their movements become less fluid, and tasks that were once easy may take longer to complete.

3. Rigidity: Muscle stiffness can occur, making it difficult to move certain parts of the body. This stiffness can lead to discomfort and pain.

4. Postural Instability: Balance issues may arise, leading to an increased risk of falls. Patients might notice that they feel unsteady or have difficulty maintaining their posture.

5. Changes in Facial Expression: A reduced ability to show facial expressions, often referred to as "masked face," can occur, making it difficult for others to gauge emotions.

6. Changes in Speech and Writing: Speech may become softer or more monotone, and handwriting may become smaller and more cramped (micrographia).

7. Sleep Disturbances: Many individuals with early PD report difficulties with sleep, including insomnia or restless leg syndrome.

Diagnosis
Diagnosing Parkinson's disease involves a comprehensive evaluation by a neurologist, typically a specialist in movement disorders. The diagnosis is primarily clinical, based on the presence of characteristic symptoms and the exclusion of other conditions.
1. Clinical Assessment: The neurologist will conduct a detailed medical history and physical examination, focusing on motor symptoms and any non-motor symptoms.

2. Neurological Tests: While there is no definitive test for PD, various tests may be conducted to rule out other conditions. These may include blood tests, MRI, or CT scans to assess brain structure.

3. Dopamine Transporter (DAT) Scan: This imaging test can help visualize dopamine transporters in the brain, which are often reduced in individuals with Parkinson's disease.

4. Response to Medication: A trial of dopaminergic medication (like levodopa) can also aid in diagnosis. If symptoms improve significantly with medication, it supports the diagnosis of PD.

Addressing Concerns
Given your symptoms of tremors, rigidity, and feelings of weakness, it is understandable to be concerned about Parkinson's disease. While your age may suggest a lower risk, it is not impossible. If you suspect PD, it is essential to consult with a neurologist who specializes in movement disorders. They can provide a thorough evaluation and recommend appropriate tests.

If you are diagnosed with Parkinson's disease and find that dopaminergic medications do not provide relief, it could suggest that your symptoms may not be due to PD. Other conditions can mimic PD symptoms, such as essential tremor or anxiety-related disorders.

Conclusion
Early diagnosis and intervention are key in managing Parkinson's disease effectively. If you are experiencing symptoms that concern you, do not hesitate to seek medical advice. A neurologist can help clarify your diagnosis and discuss potential treatment options, which may include medication, physical therapy, and lifestyle modifications to improve your quality of life. Remember, early intervention can significantly impact the progression of symptoms and overall well-being.

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