Parkinson's disease

Parkinson's disease (PD; paralysis agitans) is a neurodegenerative disease of the substantia nigra (an area in the basal ganglia of the brain). The disease was first discovered and its symptoms documented in 1817 (An Essay on the Shaking Palsy) by the British physician Dr. James Parkinson; the associated biochemical changes in the brain of patients were identified in the 1960s. Some genes were identified only recently; others remain unknown.

Diagnosis

Differential diagnosis

The differential diagnosis for a patient presenting with Parkinsonian symptoms is:

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• Idiopathic Parkinson's disease
• Essential tremor
• Parkinson plus syndromes (see below)
• Secondary parkinsonism due to drugs, toxins, stroke, head trauma, or hydrocephalus

Parkinson's tremors differ from essential tremors in that the latter are posture or action tremors, have bilateral tremors involving the hands, head and voice, and are alcohol responsive.

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In contrast, Parkinson's tremors are rest tremors, and usually start unilaterally.

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Imaging

SPECT with (FP-CIT) or PET with 18F-fluorodopa are the two imaging modalities used to assess dopamine transporter density and the integrity of nigrostriatal pathways in the central nervous system. Currently (2005) FP-CIT is widely used in Europe for the diagnostic workup of Clinically Uncertain Parkinsonian Syndromes; although it is not available in the United States.

Related Topics:
SPECT - FP-CIT - PET - Imaging

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