Tag Archives: differential-diagnosis

Parkinson's, Deep Brain Stimulation (DBS), Essential Tremors, movement disorders , , , , , , , Leave a comment

Living well with a misdiagnosis: abstract

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This is a continuation of the last post, which presented the RESULTS section of this article, as Table 1. This is the Abstract.

Living Well With (a Misdiagnosis of) Parkinson’s Disease

ABSTRACT

GOAL:

To review research related to

· Difficulty of diagnosis among and between movement disorders,

· Factors leading to misdiagnosis,
and

· Quality of Life issues experienced

BACKGROUND:

Single Subject Case Study of a 76 year old male. First reported Essential Tremor (ET) symptoms dating to teenage years. ET became disabling after five decades. ET refractory to treatment by a neurologist. Deep Brain Stimulation (DBS) chosen by subject as a last resort. Prior to DBS implants, a diagnosis of Parkinson’s Disease (PD) was made, due to rigidity observed A DATScan performed seven years after diagnosis reportedly showed abnormal dopamine transport..

Thirteen years after PD diagnosis, subject relocated and was referred to a Movement Disorders Specialist (MDS). On examination, no PD symptoms were observed. MDS began differential diagnosis based on symptoms of tremors, fatigue, and gait abnormality.

At this time, it appears that the subject’s initial presentation and diagnosis of ET (in 2010) was accurate. The later diagnosis of PD was vulnerable to confirmation bias, apparently the neurologist treating for ET had identified gait abnormality as rigidity, and failed to rule out other possible causes for arm swing asymmetry (Navarro-López et al., 2022). Heterogeneity of tremors (Fekete & Li, 2013) apparently was not investigated. Interestingly, in one of the case studies reported by Fekete & Li, a patient had been diagnosed as PD by a different neurologist, and was later determined to have ET without concurrent PD. It is not lost on this author that the references noted are later than the misdiagnosis (in December 2011). “If I knew then what I know now…”

METHODS:

Review of research articles available on PubMed Center relevant to

· Diagnostic criteria,

· Prodromal symptoms,

· Accuracy of diagnoses,

· Differentiating symptoms between ET, ET and PD, and PD.

In addition, discussion includes observable and subjective data regarding subject’s

Quality of life (QOL), including but not limited to:

· Side effects of medications,

· Dosages of medications,

· costs of medications

· Impacts of side effects, dosage, and costs for unnecessary medical interventions on other aspects of individual and social quality of life.

· Factors related to diagnosis and misdiagnosis.

Next: Quality of Life and Factors Affecting Misdiagnosis

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Essential Tremors, movement disorders, Parkinson's, Research, Reviews , , , , , , , Leave a comment

My Personal Journey with Medical Misdiagnosis

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Or, What I did last Summer

We remember, fondly or not, typical school essay topics:

  • What I did last summer
  • How my family celebrates the winter holidays
  • What America means to me
  • My favorite (TV, movie, book, song, musical group)
  • Things my parents tell me not to tell other people
  • The greatest American President

I once wrote an essay about a relative. I actually took the question seriously, instead of offering the usual platitudes. I pondered on a negative experience: the untimely death of a child. This loss could have been prevented with more timely reliance on medical providers. Of course, this happened well before penicillin became widely available for treatment of appendicitis or peritonitis. As a parent, I promptly responded when my child complained of abdominal pain. She was treated for appendicitis and survived.

This past year, my summer was also related to a missed diagnosis. Fortunately, no one died, although I had been treated for the wrong condition for over a dozen years. It has been said that physicians bury their mistakes. Not this time. Instead, the differential diagnosis and removal of medications triggered research into the differentiation between Essential Tremors and Parkinson’s Disease. Another side effect was rewording this blog’s subtitle, replacing PD with Movement Disorder. 

I submitted an abstract to the World Parkinson’s Conference. It will be held in May of 2026. Unfortunately, the abstract didn’t make the cut. Perhaps the abstract failed to include enough information, perhaps it didn’t have a positive enough bias in its presentation. Whatever. The research found misdiagnosis of movement disorders is not uncommon. Therefore I’ve decided to share it through this medium. Some people will find value in it.

Below is a table from the article. In future posts, parts of the article will be shared, including the discussion, conclusions, and references by category.

A Table contrasting common and differentiating features of Essential Tremors and Parkinson's Disease
Table 1. Commonalities and Differences (from an unpublished article on Misdiagnosis and Missed Diagnosis of Parkinson’s Disease and Essential Tremor