Neurology® Podcast General Neurologist's Practical Diagnostic Algorithm for Atypical Parkinsonian Disorders
Sep 19, 2024
Dr. Lawrence Golbe, a prominent figure at Rutgers Robert Wood Johnson Medical School, joins Dr. Jeff Ratliff and Dr. Michiko K. Bruno to discuss a practical diagnostic algorithm aimed at identifying atypical parkinsonian disorders. They explore the significant challenges of diagnosing these disorders due to symptom overlap and the lack of biomarkers. Key topics include the role of MRI in diagnosis, the need for thorough evaluations, and strategies for assessing levodopa responses, all crucial for improving patient care and outcomes.
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Challenges in Diagnosing Atypicals
- Atypical Parkinsonian disorders are challenging to diagnose early due to symptom overlap and lack of biomarkers.
- Many neurologists have limited training on these disorders, leading to under-recognition and delayed diagnosis.
Assess Levodopa Response Carefully
- Consider atypical Parkinsonism if a patient shows less than 25% motor improvement on MDS-UPDRS after 1-2 months of levodopa at ≥1000mg/day.
- Assess levodopa response quantitatively, focusing on cardinal motor symptoms, not non-motor features.
Watch for Early Falls
- Look for early balance and falling issues as key clues for atypical Parkinsonism.
- Be precise and persistent when asking about falls; don't accept trivial explanations from patients or families.