Accuracy of clinical diagnosis in tremulous parkinsonian patients: a blinded video study
Identifieur interne : 000483 ( Main/Exploration ); précédent : 000482; suivant : 000484Accuracy of clinical diagnosis in tremulous parkinsonian patients: a blinded video study
Auteurs : Nin P S. Bajaj [Royaume-Uni] ; Vamsi Gontu [Royaume-Uni] ; James Birchall [Royaume-Uni] ; James Patterson [Royaume-Uni] ; Donald G. Grosset [Royaume-Uni] ; Andrew Lees (neurologue) [Royaume-Uni]Source :
- Journal of Neurology, Neurosurgery & Psychiatry [ 0022-3050 ] ; 2010-11.
Abstract
Background This study examines the clinical accuracy of movement disorder specialists in distinguishing tremor dominant Parkinson's disease (TDPD) from other tremulous movement disorders by the use of standardised patient videos. Patients and methods Two movement disorder specialists were asked to distinguish TDPD from patients with atypical tremor and dystonic tremor, who had no evidence of presynaptic dopaminergic deficit (subjects without evidence of dopaminergic deficit (SWEDDs)) according to 123I-N-ω-fluoro-propyl- 2β-carbomethoxy-3β-(4-iodophenyl) nortropane ([123I] FP-CIT) single photon emission computed tomography (SPECT), by ‘blinded’ video analysis in 38 patients. A diagnosis of parkinsonism was made if the step 1 criteria of the Queen Square Brain Bank criteria for Parkinson's disease were fulfilled. The reviewer diagnosis was compared with the working clinical diagnosis drawn from the medical history, SPECT scan result, long term follow-up and in some cases the known response to dopaminergic medications. This comparison allowed a calculation for false positive and false negative rate of diagnosis of PD. Results High false positive (17.4-26.1%) and negative (6.7-20%) rates were found for the diagnosis of PD. The diagnostic distinction of TDPD from dystonic tremor was reduced by the presence of dystonic features in treated and untreated PD patients. Conclusion Clinical distinction of TDPD from atypical tremor, monosymptomatic rest tremor and dystonic tremor can be difficult due to the presence of parkinsonian features in tremulous SWEDD patients. The diagnosis of bradykinesia was particularly challenging. This study highlights the difficulty of differentiation of some cases of SWEDD from PD.
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DOI: 10.1136/jnnp.2009.193391
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Grosset</name><affiliation wicri:level="1"><country xml:lang="fr">Royaume-Uni</country><wicri:regionArea>Institute of Neurological Sciences, Southern General Hospital, Glasgow</wicri:regionArea><wicri:noRegion>Glasgow</wicri:noRegion></affiliation></author><author><name sortKey="Lees, Andrew J" sort="Lees, Andrew J" uniqKey="Lees A" first="Andrew J" last="Lees">Andrew Lees (neurologue)</name><affiliation wicri:level="3"><country xml:lang="fr">Royaume-Uni</country><wicri:regionArea>Queen Square Brain Bank for Neurological Disorders and Institute of Neurology, University College, London</wicri:regionArea><placeName><settlement type="city">Londres</settlement><region type="country">Angleterre</region><region type="région" nuts="1">Grand Londres</region></placeName><placeName><settlement type="city">Londres</settlement><region type="country">Angleterre</region><region type="région" nuts="1">Grand Londres</region></placeName><orgName>National Hospital for Neurology and Neurosurgery</orgName></affiliation></author></analytic><monogr></monogr><series><title level="j">Journal of Neurology, Neurosurgery & Psychiatry</title><title level="j" type="abbrev">J Neurol Neurosurg Psychiatry</title><idno type="ISSN">0022-3050</idno><idno type="eISSN">1468-330X</idno><imprint><publisher>BMJ Publishing Group Ltd</publisher><date type="published" when="2010-11">2010-11</date><biblScope unit="volume">81</biblScope><biblScope unit="issue">11</biblScope><biblScope unit="page" from="1223">1223</biblScope></imprint><idno type="ISSN">0022-3050</idno></series><idno type="istex">5483118390B584479283DD2909329A273418625D</idno><idno type="DOI">10.1136/jnnp.2009.193391</idno><idno type="href">jnnp-81-1223.pdf</idno><idno type="ArticleID">jnnp193391</idno><idno type="PMID">20547625</idno><idno type="local">jnnp;81/11/1223</idno></biblStruct></sourceDesc><seriesStmt><idno type="ISSN">0022-3050</idno></seriesStmt></fileDesc><profileDesc><textClass></textClass><langUsage><language ident="en">en</language></langUsage></profileDesc></teiHeader><front><div type="abstract">Background This study examines the clinical accuracy of movement disorder specialists in distinguishing tremor dominant Parkinson's disease (TDPD) from other tremulous movement disorders by the use of standardised patient videos. Patients and methods Two movement disorder specialists were asked to distinguish TDPD from patients with atypical tremor and dystonic tremor, who had no evidence of presynaptic dopaminergic deficit (subjects without evidence of dopaminergic deficit (SWEDDs)) according to 123I-N-ω-fluoro-propyl- 2β-carbomethoxy-3β-(4-iodophenyl) nortropane ([123I] FP-CIT) single photon emission computed tomography (SPECT), by ‘blinded’ video analysis in 38 patients. A diagnosis of parkinsonism was made if the step 1 criteria of the Queen Square Brain Bank criteria for Parkinson's disease were fulfilled. The reviewer diagnosis was compared with the working clinical diagnosis drawn from the medical history, SPECT scan result, long term follow-up and in some cases the known response to dopaminergic medications. This comparison allowed a calculation for false positive and false negative rate of diagnosis of PD. Results High false positive (17.4-26.1%) and negative (6.7-20%) rates were found for the diagnosis of PD. The diagnostic distinction of TDPD from dystonic tremor was reduced by the presence of dystonic features in treated and untreated PD patients. Conclusion Clinical distinction of TDPD from atypical tremor, monosymptomatic rest tremor and dystonic tremor can be difficult due to the presence of parkinsonian features in tremulous SWEDD patients. The diagnosis of bradykinesia was particularly challenging. This study highlights the difficulty of differentiation of some cases of SWEDD from PD.</div></front></TEI><affiliations><list><country><li>Royaume-Uni</li></country><region><li>Angleterre</li><li>Grand Londres</li></region><settlement><li>Londres</li></settlement><orgName><li>National Hospital for Neurology and Neurosurgery</li></orgName></list><tree><country name="Royaume-Uni"><noRegion><name sortKey="Bajaj, Nin P S" sort="Bajaj, Nin P S" uniqKey="Bajaj N" first="Nin P S" last="Bajaj">Nin P S. Bajaj</name></noRegion><name sortKey="Bajaj, Nin P S" sort="Bajaj, Nin P S" uniqKey="Bajaj N" first="Nin P S" last="Bajaj">Nin P S. Bajaj</name><name sortKey="Bajaj, Nin P S" sort="Bajaj, Nin P S" uniqKey="Bajaj N" first="Nin P S" last="Bajaj">Nin P S. Bajaj</name><name sortKey="Birchall, James" sort="Birchall, James" uniqKey="Birchall J" first="James" last="Birchall">James Birchall</name><name sortKey="Gontu, Vamsi" sort="Gontu, Vamsi" uniqKey="Gontu V" first="Vamsi" last="Gontu">Vamsi Gontu</name><name sortKey="Grosset, Donald G" sort="Grosset, Donald G" uniqKey="Grosset D" first="Donald G" last="Grosset">Donald G. Grosset</name><name sortKey="Lees, Andrew J" sort="Lees, Andrew J" uniqKey="Lees A" first="Andrew J" last="Lees">Andrew Lees (neurologue)</name><name sortKey="Patterson, James" sort="Patterson, James" uniqKey="Patterson J" first="James" last="Patterson">James Patterson</name></country></tree></affiliations></record>Pour manipuler ce document sous Unix (Dilib)
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