Objective: To report 10 movement disorder cases misdiagnosed by general neurologists as another disorder or a different category of movement disorder.

Background: The misdiagnosis of movement disorders is a common occurrence in general neurology, even on tertiary specialized centers. We observed that it was not infrequent to encounter referrals misdiagnosed with other disorders or a different movement disorder.

Method: We reviewed patient records and videotapes from a tertiary academic center in the Dominican Republic of cases who were misdiagnosed by a general neurologist with another disorder and referred or consulted to a movement disorder specialist for further evaluation.

Results: We selected 10 patients out of which 9/10 were referrals evaluated as outpatients and 1/10 was an ICU consult. The most common prior diagnosis was Parkinson Disease (PD). A parkinsonism type was identified in 9/10, and dystonia in 3/10. Out of the patients with parkinsonism and not PD, a distribution of progressive supranuclear palsy, multiple system atrophy, atypical parkinsonisms and hemydistonia-hemiparkinsonism was found. One of them had a previous diagnosis of cervical disk herniation. Only 3 patients had PD; with a previous diagnosis of stroke, vascular dementia and a vertiginous syndrome, respectively. Of the dystonia patients, 1/2 had primary generalized dystonia of the adult, with a previous diagnosis of paroxysmal dyskinesias throughout pregnancy; and the other had had Bell’s palsy with hemifacial spasms, yet priorly though to be a persistence of the initial palsy. All patients had more than a 5-year delay in diagnosis, and management modification was done with improvement in their quality of life in those not yet at advanced disease.

Conclusion: We highlight, through this case series, the importance of CME for general neurologists to accurately diagnose movement disorders through precise clinical description and adequate recognition of the type of movement disorder. This is based on phenomenology to different categories, such as tremor, parkinsonism, etc [1]. Therefore, it is necessary to identify the current challenges in lack of education, training, and resources for general neurologists with limited expertise and to consider early referral to a movement disorder specialist to properly treat these patients offering them a better quality of life throughout their disease by diminishing the burden of their symptoms.

References: Merchant S. H. I. (2022). Emerging role of clinical neurophysiology in the diagnosis of movement disorders. Clinical neurophysiology practice, 7, 49–50. https://doi.org/10.1016/j.cnp.2022.01.003

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MDS Abstracts - https://www.mdsabstracts.org/abstract/misdiagnosing-movement-disorders-on-a-terciary-academic-center-in-the-caribbean-a-series-of-cases/