Objective: The aim of this work was to describe the features of patients with an incorrect diagnosis of Parkinson’s disease (PD) during a long-term clinical follow-up.

Background: Diagnosis of PD is manly clinical, based on definite criteria (1). Meticulous neurological examination is required to find motor and non-motor PD manifestations and to exclude red flags. However, the accuracy of clinical diagnosis is not optimal (2). In ambiguous cases, dopamine transporter (DaT) single photon emission computed tomography (SPECT) can help to avoid mistaken diagnosis.

Methods: We collected data from 22 patients with a diagnosis of PD, who presented atypical features in disease evolution. We analyzed demographic and clinical characteristics and antiparkinsonian drugs intake. Brain MRI and Dat-SPECT were performed when required. We identified the causes of mistaken PD diagnosis and the final diagnosis.

Results: Mean age at PD diagnosis was 59.1± 14.5 years. Signs and symptoms at onset were isolated or combined rest tremor (n=17), gait instability (n=5), micrographia (n=4) and akineto-rigid syndrome (n=4). Mean disease duration before diagnosis reevaluation was 8.9± 5.2 years. All patients were treated by antiparkinsonian drugs with a mean levodopa equivalent dose (LED) of 530.3± 522.4 mg. DaT-SPECT was performed in 17 patients, resulted as normal. The main evidences of mistaken diagnosis were: paucity of akinetic features, antiparkinsonian drugs’ inefficacy without side effects, distraction and suggestibility during clinical examination, and normal Dat-SPECT. The most frequent final diagnosis were essential tremor (n=10) and functional movement disorders (n=8), followed by normal pressure hydrocephalus (n=1), anoxic injury with bilateral pallidal lesions (n=1), lumbar spinal stenosis (n=1) and neuroleptic drug treatment (n=1).

Conclusions: Revision of PD diagnosis, during a long follow-up, should be considered in the absence of classic PD clinical evolution. In conclusion, to define PD diagnosis we suggest: a) to follow clinical criteria; b) to reconsider PD diagnosis if atypical features are present; c) to evoke essential tremor and psychogenic disorders as differential diagnosis.

References: 1. Postuma RB, Berg D, Stern M, Poewe W, Olanow CW, Oertel W, Obeso J, Marek K, Litvan I, Lang AE, Halliday G, Goetz CG, Gasser T, Dubois B, Chan P, Bloem BR, Adler CH, Deuschl G. MDS clinical diagnostic criteria for Parkinson’s disease. Mov Disord. 2015 Oct;30(12):1591-601. 2. Rizzo G, Copetti M, Arcuti S, Martino D, Fontana A, Logroscino G. Accuracy of clinical diagnosis of Parkinson disease: A systematic review and meta-analysis. Neurology. 2016 Feb 9;86(6):566-76.

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MDS Abstracts - https://www.mdsabstracts.org/abstract/revision-of-parkinsons-disease-diagnosis-during-a-long-term-follow-up/