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Is It Possible To Mistake Essential Tremors For Parkinson's Disease?
Question: My dad is 72 and has been treated lately for fatigue and
shortness of breath. He was given levaquin for a lung infection
and developed numbness in his face. He was admitted to the
hospital to rule out stroke and the doctor noticed a tremor in
his left hand while at rest. He immediately said it was Parkinsons.
The problem is my grandfather had the same type tremor for
nearly 15 years before he died and he was never treated for
it and it never progressed, leading me to believe it was fairly
severe essential tremor. That is what I assumed my dad has
since it is hereditary. Do you think the doctor jumped to the
conclusion too fast considering the history of my grandfather?
Can essential tremor be mistaken for Parkinsons? Or, if in fact
my grandfather actually unknowingly had Parkinsons, can it
stay in a mild form and not progress?
shortness of breath. He was given levaquin for a lung infection
and developed numbness in his face. He was admitted to the
hospital to rule out stroke and the doctor noticed a tremor in
his left hand while at rest. He immediately said it was Parkinsons.
The problem is my grandfather had the same type tremor for
nearly 15 years before he died and he was never treated for
it and it never progressed, leading me to believe it was fairly
severe essential tremor. That is what I assumed my dad has
since it is hereditary. Do you think the doctor jumped to the
conclusion too fast considering the history of my grandfather?
Can essential tremor be mistaken for Parkinsons? Or, if in fact
my grandfather actually unknowingly had Parkinsons, can it
stay in a mild form and not progress?
Brief Answer:
Parkinson and essential tremor usually easy to tell apart.
Detailed Answer:
I read your question carefully and I understand your concern.
Usually it is hard for a Parkinsonian tremor to be mistaken for essential tremor. Parkinsonian tremor is at rest and relieved when moving the hand towards a target, is unilateral at first only later bilateral, has a lower frequency. Essential tremor on the other hand is bilateral, increases when attempting to reach a target, higher frequency. Also if it has appeared only now unlikely to be essential as it usually appears much earlier.
If it is Parkinson disease it does progress, slowly over the years, but it does. So I can't explain why it didn't in your grandfather as 15 years are a lot, must have been something else.
Now of course I hope the doctor didn't make the diagnosis simply by looking at the tremor. To make the diagnosis of Parkinson other criteria are necessary such as rigidity and bradikinesia (slowness of movements). So for that a detailed neurological exam is necessary by examining the limbs, certain movement, coordination tests as well as gait observation. Also brain imaging to check for mimics like stroke in certain areas of the brain dealing with movement control. If he's been prescribed medication improvement by medication is also a confirmation. If all those other signs are there on physical exam I think the diagnosis is confirmed.
I remain at your disposal for further questions.
Parkinson and essential tremor usually easy to tell apart.
Detailed Answer:
I read your question carefully and I understand your concern.
Usually it is hard for a Parkinsonian tremor to be mistaken for essential tremor. Parkinsonian tremor is at rest and relieved when moving the hand towards a target, is unilateral at first only later bilateral, has a lower frequency. Essential tremor on the other hand is bilateral, increases when attempting to reach a target, higher frequency. Also if it has appeared only now unlikely to be essential as it usually appears much earlier.
If it is Parkinson disease it does progress, slowly over the years, but it does. So I can't explain why it didn't in your grandfather as 15 years are a lot, must have been something else.
Now of course I hope the doctor didn't make the diagnosis simply by looking at the tremor. To make the diagnosis of Parkinson other criteria are necessary such as rigidity and bradikinesia (slowness of movements). So for that a detailed neurological exam is necessary by examining the limbs, certain movement, coordination tests as well as gait observation. Also brain imaging to check for mimics like stroke in certain areas of the brain dealing with movement control. If he's been prescribed medication improvement by medication is also a confirmation. If all those other signs are there on physical exam I think the diagnosis is confirmed.
I remain at your disposal for further questions.
Above answer was peer-reviewed by :
Dr. Chakravarthy Mazumdar
He did not do a physical exam he just
looked at the tremor. I am sure he will
but he hasn't yet. He said the Ct was good
but did show a XXXXXXX stroke.
If it is Parkinsons, he is 72 so how long
would it typically take for the disease to
progress to the point of disability? He still
works and is physically active and the only
symptom he has is the tremor in one hand
(which he has had for a about a year). Thanks!
looked at the tremor. I am sure he will
but he hasn't yet. He said the Ct was good
but did show a XXXXXXX stroke.
If it is Parkinsons, he is 72 so how long
would it typically take for the disease to
progress to the point of disability? He still
works and is physically active and the only
symptom he has is the tremor in one hand
(which he has had for a about a year). Thanks!
Brief Answer:
Read below.
Detailed Answer:
Thank you for the feedback.
He should be examined no doubt about that. I often say someone has Parkinson's only by noticing the tremor as well, but that doesn't mean I ommit the rest of the exam, after all there are no specific tests for Parkinson's, the diagnosis is made by physical exam.
As for the prognosis, it is of course in the case of the elderly a question also of accompanying conditions which are common with age and restrict mobility. In male patients progression is somewhat faster unfortunately. With good medical monitoring and careful medication use, in an otherwise healthy active person, I would say he should be independent for at least 5 years, but have had plenty of patients who are active after 10 or even 15 years.
I hope to have been of help.
Read below.
Detailed Answer:
Thank you for the feedback.
He should be examined no doubt about that. I often say someone has Parkinson's only by noticing the tremor as well, but that doesn't mean I ommit the rest of the exam, after all there are no specific tests for Parkinson's, the diagnosis is made by physical exam.
As for the prognosis, it is of course in the case of the elderly a question also of accompanying conditions which are common with age and restrict mobility. In male patients progression is somewhat faster unfortunately. With good medical monitoring and careful medication use, in an otherwise healthy active person, I would say he should be independent for at least 5 years, but have had plenty of patients who are active after 10 or even 15 years.
I hope to have been of help.
Above answer was peer-reviewed by :
Dr. Chakravarthy Mazumdar
Answered by
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