Atypical features include early onset falling, symmetric symptoms at onset, severe speech or swallowing problems, early dementia, marked autonomic dysfunction such as markedly low blood pressure, and a poor response to Levodopa. Although a good response to Levodopa is often suggestive of Parkinson’s disease, only 77% of pathologically proven cases had a “good” or “excellent” initial response to Levodopa in a recent series. Furthermore, a significant percentage of patients with parkinsonism but not Parkinson’s disease responded to Levodopa. Therefore, although improvement with Levodopa supports the diagnosis of Parkinson’s disease, response to Levodopa cannot be used reliably to differentiate Parkinson’s disease from other parkinsonian disorders. In summary, the diagnosis of Parkinson’s disease often can be difficult, not possible with one consultation, and often requires a period of observation. I often see patients who have been incorrectly diagnosed. Due to the complexity of the diagnosis and treatment of Parkinson’s disease, I recommend that patients be evaluated at some point by a Neurologist with expertise in movement disorders.

Dr. John Campbell, PASFI’s Medical Director, is Director of the Parkinson’s Disease and Movement Disorders Center at Collier Neurologic Specialists which is located at 730 Goodlette Road, Suite 100, Naples FL. The telephone number is 239-262-8971