The initial symptoms of Parkinson’s disease tend to be discreet and difficult to identify, which makes diagnosis a complex and often time-consuming process. Among the first signs are a decrease in voice tone, changes in writing and reduced facial expression.
Last Saturday (9), Dr. Roberto Kalil and neurologists Roberta Saba and Rubens Cury addressed the challenges of diagnosing the disease and clarified doubts about its different clinical manifestations.
Specialist in movement disorders and (Federal University of São Paulo), Roberta Saba highlighted that not all Parkinson’s patients have tremors. “It can present a form of rigidity and slowness or a trembling form”, he explained.
Among the first signs that may appear, she mentioned , a situation in which family members begin to notice that the patient speaks more quietly or in a slurred manner.
Another early sign highlighted by Saba is the so-called micrographia, a change in writing in which the letter becomes progressively smaller. Reduction in facial expression and slowness in daily activities were also identified as initial manifestations. “These are the most subtle signs that can be confused with aging,” said the neurologist.
Roberta Saba further explained that Parkinson’s disease usually begins unilaterally, initially affecting only one side of the body. She reported the case of a patient who noticed the problem when seeing herself in a mirror: “When she walked, one side of her body, her arm didn’t move.” This phenomenon, called bradykinesia, refers to decreased movement and is a characteristic sign of the disease.
The specialist also warned of the importance of not confusing Parkinson’s tremor with essential tremor. While essential tremor occurs during movement, such as when writing or holding an object, Parkinson’s tremor occurs at rest, when there is no muscle contraction. “They are different tremors. This is very important not to create confusion in terms of diagnosis”, highlighted Saba.
Clinical and time-consuming diagnosis
Coordinator of the Movement Disorders and Parkinson’s Disease Group at HCFMUSP (Hospital das Clínicas da Faculdade de Medicina da USP), Rubens Cury explained why diagnosing the disease still represents a challenge. According to him, when the initial symptoms do not include tremor, the patient can seek other specialists before reaching the neurologist.
“Patients sometimes look for an orthopedist because their shoulder is a little sore”, he explained.
Cury added that, in more severe forms of the disease, diagnosis tends to take longer. Even experienced neurologists may not be able to make the diagnosis in the first consultation, and it is necessary to monitor the evolution of symptoms over time.
“Sometimes, we even treat it as if it were Parkinson’s and see the therapeutic response,” he said, explaining that the response to dopamine replacement is one of the criteria used to confirm the diagnosis.
