Download PDF
CC BY-NC-ND 4.0 · Arq Neuropsiquiatr 2016; 74(10): 781-784
DOI: 10.1590/0004-282X20160126
ARTICLE

Unusual motor and non-motor symptoms and signs in the early stage of Parkinson’s disease

Sintomas e sinais motores e não motores pouco comuns na fase inicial da doença de Parkinson
Hélio A. G. Teive
1   Universidade Federal do Paraná, Hospital de Clínicas, Serviço de Neurologia, Unidade de Distúrbios do Movimento, Curitiba PR, Brasil;
,
Délcio C. Bertucci Filho
2   Universidade Estadual de Ponta Grossa, Departamento de Medicina Interna, Serviço de Neurologia, Ponta Grossa PR, Brasil;
,
Renato P. Munhoz
3   Toronto University, Toronto Western Hospital, Movement Disorders Centre, Toronto ON, Canada.
› Author Affiliations
› Further Information
Also available at
   Permissions and Reprints

ABSTRACT

Objective Patients with Parkinson’s disease (PD) may present with unusual motor and non-motor symptoms and signs in the early stage of the disease.

Methods Cases were collected over a five-year period at two tertiary movement disorders clinics. All had a diagnosis of PD with unusual presentations defined retrospectively as the presence of complaints not objectively related to any of the classic cardinal signs of parkinsonism or the typical early non-motor features of PD.

Results A total of 15 early PD patients fulfilled the proposed criteria, presenting with symptoms such as atypical tremors, shoulder pain, signs related to the rigid akinetic syndrome, as well as cases of asthenia, rhinorrhea, parosmia, dysgeusia, nocturnal sialorrhea, and color discrimination disorders.

Conclusions Unusual motor and non-motor symptoms and signs in the early stage of PD can be difficult to interpret. Specialists should be aware of these conditions as clues to a potential diagnosis.

RESUMO

Objetivo Pacientes com doença de Parkinson (DP) podem apresentar sintomas e sinais motores e não motores pouco comuns na fase inicial da doença.

Métodos Os casos foram coletados em um período de cinco anos, em dois centros terciários de distúrbios do Movimento. Todos os pacientes tinham o diagnóstico de DP com apresentações clínicas iniciais pouco comuns.

Resultados Um total de 15 pacientes com DP na fase inicial, apresentando sintomas e sinais tais como, tremores atípicos, dor no ombro, sinais relacionados com a síndrome rígido-acinética, bem como casos com astenia, rinorréia, parosmia, disgeusia, sialorréia noturna e distúrbios da discriminação de cores.

Conclusões Sintomas e sinais motores e não motores pouco comuns na fase inicial da DP podem ser de difícil interpretação. Neurologistas devem estar a par destas condições, como pistas para o potencial diagnóstico.

Parkinson disease - signs and symptoms
doença de Parkinson - sinais e sintomas


Publication History

Received: 23 March 2016

Accepted: 30 June 2016

Article published online:
06 September 2023

© 2023. Academia Brasileira de Neurologia. This is an open access article published by Thieme under the terms of the Creative Commons Attribution-NonDerivative-NonCommercial License, permitting copying and reproduction so long as the original work is given appropriate credit. Contents may not be used for commecial purposes, or adapted, remixed, transformed or built upon. (https://creativecommons.org/licenses/by-nc-nd/4.0/)

Thieme Revinter Publicações Ltda.
Rua do Matoso 170, Rio de Janeiro, RJ, CEP 20270-135, Brazil

 

  • References

  • 1 Munhoz RP, Werneck LC, Teive HA. The differential diagnoses of parkinsonism: findings from a cohort of 1528 patients and a 10 years comparison in tertiary movement disorders clinics. Clin Neurol Neurosurg. 2010;112(5):431-5. doi:10.1016/j.clineuro.2010.03.003
  • 2 Thenganatt MA, Jankovic J. Parkinson disease subtypes. JAMA Neurol 2014;71(4):499-504. doi:10.1001/jamaneurol.2013.6233
  • 3 Silveira-Moriyama L, Lees AJ. Parkinson disease: how reliable are prodromal indicators of Parkinson disease? Nat Rev Neurol. 2015;11(1):5-6. doi:10.1038/nrneurol.2014.235
  • 4 Munhoz RP, Teive HA, Eleftherohorinou H, Coin LJ, Lees AJ, Silveira-Moriyama L. Demographic and motor features associated with the occurrence of neuropsychiatric and sleep complications of Parkinson’s disease. J Neurol Neurosurg Psychiatry. 2013;84(8):883-7. doi:10.1136/jnnp-2012-304440
  • 5 Munhoz RP, Moro A, Silveira-Moriyama L, Teive HA. Non-motor signs in Parkinson’s disease: a review. Arq Neuropsiquiatr. 2015;73(5):454-62. doi:10.1590/0004-282X20150029
  • 6 Shulman LM, Singer C, Bean JA, Weiner WJ. Internal tremor in patients with Parkinson’s disease. Mov Disord. 1996;11(1):3-7. doi:10.1002/mds.870110103
  • 7 Cochrane GD, Rizvi S, Abrantes A, Crabtree B, Cahill J, Friedman JH. Internal tremor in Parkinson´s disease, multiple sclerosis, and essential tremor. Parkinsonism Relat Disord. 2015;21(10):1145-7. doi:10.1016/j.parkreldis.2015.07.014
  • 8 Hellmann MA, Melamed E, Steinmetz AP, Djaldetti R. Unilateral lower limb rest tremor is not necessarily a presenting symptom of Parkinson’s disease. Mov Disord. 2010;25(7):924-7. doi:10.1002/mds.23030
  • 9 Teive HA, Sá DS. The Rolex sign: first manifestation of Parkinson´s disease: case report. Arq Neuropsiquiatr. 2000;58(3A):724-5. doi:10.1590/S0004-282X220160126400020
  • 10 Manfredi M, Teive HA, Pedace T, Andrade LAF, Ferraz HB, Curra A. C. David Marsden and Rolex sign. Neurol Sci. 2003;24(1):45-6. doi:10.1007/s100720300023
  • 11 Kwon KY, Kim M, Lee SM, Kang SH, Lee HM, Koh SB. Is reduced arm and leg swing in Parkinson’s disease associated with rigidity or bradykinesia? J Neurol Sci. 2014;341(1-2):32-5. doi:10.1016/j.jns.2014.03.041
  • 12 Ebersbach G, Moreau C, Gandor F, Defebvre L, Devos D. Clinical syndromes: parkinsonian gait. Mov Disord. 2013;28(11):1552-9. doi:10.1002/mds.25675
  • 13 Goetz CG, Tanner CM, Levy M, Wilson RS, Garron DC. Pain in Parkinson´s disease. Mov Disord. 1986;1(1):45-9. doi:10.1002/mds.870010106
  • 14 Cleeves L, Findley L. Frozen shoulder and other shoulder disturbancies in Parkinson’s disease. J Neurol Neurosurg Psychiatry. 1989;52(6):813-4. doi:10.1136/jnnp.52.6.813-b
  • 15 Stamey W, Davidson A, Jankovic J. Shoulder pain: a presenting symptom of Parkinson disease. J Clin Rheumatol. 2008;14(4):253-4. doi:10.1097/RHU.0b013e3181826d43
  • 16 Kim YE, Lee WW, Yun JY, Yang HJ, Kim HJ, Jeon BS. Musculoskeletal problems in Parkinson’s disease: neglected issues. Parkinsonism Relat Disord. 2013;19(7):666-9. doi:10.1016/j.parkreldis.2013.03.002
  • 17 Berardelli A, Conte A, Fabbrini G, Bologna M, Latorre A, Rocchi L et al. Pathophysiology of pain and fatigue in Parkinson´s disease. Parkinsonism Relat Disord. 2012;18(Suppl 1):S226-8. doi:10.1016/S1353-8020(11)70069-4
  • 18 Koh SB, Roh JH, Kim JH, Oh K, Kim BJ, Kim GS et al. Ultrasonographic findings of shoulder disorders in patients with Parkinson’s disease. Mov Disord. 2008;23(12):1772-6. doi:10.1002/mds.22191
  • 19 Cochrane GD, Rizvi S, Abrantes AM, Crabtree B, Cahill J, Friedman JH. The association between fatigue and apathy in patients with either Parkinson’s disease or multiple sclerosis. Parkinsonism Relat Disord. 2015;21(9):1093-5. doi:10.1016/j.parkreldis.2015.07.007
  • 20 Kano O, Yoshioka M, Nagayama H, Hamada S, Maeda T, Hasegawa T et al. Rhinorrhea in Parkinson´s disease: a consecutive multicenter study in Japan. J Neurol Sci. 2014;343(1-2):88-90. doi:10.1016/j.jns.2014.05.039
  • 21 Kashihara K, Hanaoka A, Imamura T. Frequency and characteristics of taste impairment in patients with Parkinson´s disease: results of a clinical interview. Intern Med. 2011;50(20):2311-5. doi:10.2169/internalmedicine.50.5935
  • 22 Doty RL. Olfactory dysfunction in Parkinson´s disease. Nat Rev Neurol. 2012;8(6):329-39. doi:10.1038/nrneurol.2012.80
  • 23 Silveira-Moriyama L, Munhoz RP, Carvalho MJ, Raskin S, Rogaeva E, Aguiar PC et al. Olfactory heterogeneity in LRRK2 related Parkinsonism. Mov Disord. 2010;25(16):2879-83. doi:10.1002/mds.23325
  • 24 Srivanitchapoom P, Pandey S, Hallett M. Drooling in Parkinson´s disease: a review. Parkinsonism Relat Disord. 2014;20(11):1109-18. doi:10.1016/j.parkreldis.2014.08.013
  • 25 Kertelge L, Brüggemann N, Schmidt A, Tadic V, Wisse C, Dankert S et al. Impaired sense of smell and color discrimination in monogenic and idiopathic Parkinson’s disease. Mov Disord. 2010;25(15):2665-9. doi:10.1002/mds.23272