Can Spinal Stenosis Mimic Parkinson’s

New Diagnostic Standards For Parkinsons

Until recently, the gold-standard checklist for diagnosis came from the U.K.s Parkinsons Disease Society Brain Bank. It was a checklist that doctors followed to determine if the symptoms they saw fit the disease. But thats now considered outdated. Recently, new criteria from the International Parkinson and Movement Disorder Society have come into use. This list reflects the most current understanding of the condition. It allows doctors to reach a more accurate diagnosis so patients can begin treatment at earlier stages.

How Are They Alike

MS and Parkinsonâs both affect your central nervous system, which includes your brain and spinal cord. Thatâs why they both can affect how you move, sleep, feel, and talk.

These diseases both affect your nerves. MS can break down the coating, called myelin, that surrounds and protects your nerves. In Parkinsonâs, nerve cells in a part of your brain slowly die off.

Both can start out with mild symptoms, but they get worse over time.

Common symptoms of both diseases include:

• Shaky fingers, hands, lips, or limbs
• Slurred speech thatâs hard for others to understand
• Numb or weak limbs that make your walk unsteady
• Loss of muscle control that often affects one side of your body at first, then later both
• Spastic limb movements that are hard to control
• Loss of bladder or bowel control
• Poor balance

Depression is another symptom common to both conditions.

What Are The Symptoms Of Spinal Stenosis

Symptoms of spinal stenosis happen when the spaces within the spine narrow and put pressure on the spine. This occurs most often in the lower back and neck. For most people, symptoms develop slowly, and some people may not have any symptoms.

Symptoms of spinal stenosis in the lower back can include:

• Pain in the lower back.
• Burning pain or ache that spreads down the buttocks and into the legs, that typically worsens with standing or walking and gets better with leaning forward.
• Numbness, tingling, or cramping in the legs and feet. These may get worse when you stand or walk.
• Weakness in the legs and feet.

Symptoms of spinal stenosis in the neck may include:

• Neck pain.
• Numbness or tingling that spreads down the arms into the hands.
• Weakness in a hand, arm, or fingers.

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How Do I Prevent Falls From Common Hazards

• Floors: Remove all loose wires, cords, and throw rugs. Minimize clutter. Make sure rugs are anchored and smooth. Keep furniture in its usual place.
• Bathroom: Install grab bars and non-skid tape in the tub or shower. Use non-skid bath mats on the floor or install wall-to-wall carpeting.
• Lighting: Make sure halls, stairways, and entrances are well-lit. Install a night light in your bathroom or hallway and staircase. Turn lights on if you get up in the middle of the night. Make sure lamps or light switches are within reach of the bed if you have to get up during the night.
• Kitchen: Install non-skid rubber mats near the sink and stove. Clean spills immediately.
• Stairs: Make sure treads, rails, and rugs are secure. Install a rail on both sides of the stairs. If stairs are a threat, it might be helpful to arrange most of your activities on the lower level to reduce the number of times you must climb the stairs.
• Entrances and doorways: Install metal handles on the walls adjacent to the doorknobs of all doors to make it more secure as you travel through the doorway.

Strengthening Exercises Or Stretching May Be Helpful

Imagine that the spine is like a telephone pole or the mast of a sailboat. If the pole is not exactly upright, even a slight tilt requires a great force to keep it from tilting further and falling. In the human body, this means that the lower back muscles are under great stress. It also means that the tension on the back bones is much increased as well. This worsens whatever problems, like arthritis, that are already present. The same process applies to the neck, although the forces are less great. Strengthening exercises or stretching may be helpful. Almost everyone over the age of 60 has arthritis in their spine. Luckily most dont have pain from it, but those who do will have it worsened by the spine curvature caused by the PD.

PD patients also frequently have an aching discomfort in their muscles, particularly in the thighs and shoulders. I think this is due to the rigidity, or stiffness, that is part of the Parkinsons Disease syndrome, but Ive seen many patients with this pain and no apparent stiffness on examination, hence not explained. It is common and it often, but not always, responds to alterations of the usual Parkinsons Disease medications for movement. Exercise and stretching may be helpful as well and should always be tried first before increasing medications.

Pain is a challenge in PD. We cant measure it and often cannot find its cause. It is, however, often treatable, and reducing pain improves quality of life.

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Lower Back Pain And Back Of The Neck Pain Are Most Common

Pain occurs for a number of reasons and its not always clear what the cause is, making it difficult to figure out how best to treat it. I believe that most common pain problems in Parkinsons Disease are the same as in the general population, but amplified. Low back pain and back of the neck pain are probably the most common pain conditions in PD. The reason Parkinsons Disease patients have so many problems with their low back and their neck is their posture. Parkinsons Disease causes a stooped posture. Some of this happens with age anyway, particularly in women after menopause when their bones soften, but is always worse from the PD. All Parkinsons Disease patients have some degree of stooped posture and many also tilt to one side. Because of the stooped posture, the muscles in the lower back have to pull much harder to keep the spine upright.

Know About Parkinson’s Disease

Parkinson’s disease is a severe problem related to the nervous system that significantly affects your ability to control body movement. The disease seems not so severe initially but turns eventually. A person with Parkinson’s disease may experience shaking, muscle stiffness, problems in balancing and coordinating. Behavioral changes and other severe symptoms can be witnessed as the disease continues to progress.

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Secondary Paroxysmal Dyskinesias Including Paroxysmal Tonic Spasms In Multiple Sclerosis And Neuromyelitis Optica Spectrum Disorders

Secondary paroxysmal dyskinesias may involve the spinal cord. Important clues that a paroxysmal dyskinesia is secondary rather than primary include the presence of significant pain and an abnormal interictal examination. Secondary paroxysmal dyskinesias may occur in hypoparathyroidism , pseudohypoparathyroidism , supraspinal lesions , spinal cord glioma and spinal cord compression .

The pathophysiology of paroxysmal tonic spasms in MS or NMOSD remains unclear. Osterman and Westerberg proposed that ephaptic transmission between demyelinated axons might be responsible. Alteration in supraspinal control might lead to a reduction in inhibitory spinal interneuron output, resulting in hyperexcitation of the alpha-motor neuron. Paroxysmal tonic spasms in MS or NMOSD are typically treated with low-dose carbamazepine or acetazolamide . Gabapentin has also been reported to be effective .

Operative Procedure & Postoperative Course

Considering the patientâs degree of deformity and pain, we elected to perform revision surgery. Pedicle screws and rods were reinserted from the L1to S1 levels with iliac screws after performing a partial pedicle subtraction osteotomy at the L4 level with removal of the intervertebral discs at the level of L34 . The patientâs intraoperative and postoperative periods were uneventful, and she was able to walk with a straight back without any support a few days postoperatively. Follow-up X-rays obtainedapproximately 18 months after surgery showed significant improvement in her spinal parameters and kyphoscoliosis. Pre and postoperative surgical outcomes were measured with Modified Scoliosis Research Society-23 Outcome Instrument scoring system . A mean postoperative score of 20 out of 25 indicated a satisfactory outcome.

Lateral thoracolumbar X-ray showing PPSO & discectomy performed at the L4 and L34 level, respectively, and lateral thoracolumbar X-ray showing the correction angle of approximately 30 degrees at the same level postoperatively. PPSO : partial pedicle subtraction osteotomy.Follow-up anteroposterior and lateral whole spine X-rays showing satisfactory correction of coronal and sagittal imbalance. *Indicates the lumbar lordosis, **Indicates sagittal vertical axis. PI : pelvic incidence, LL : lumbar lordosis, SVA : sagittal vertical axis.

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A Differential Diagnosis May Be Needed To Pinpoint The Actual Cause

• Autoimmune Diseases

If you are experiencing neurological symptoms, do not necessarily assume you have multiple sclerosis , especially considering there are a number of other conditions that can mimic it. Seeing a healthcare provider for an evaluation is critical before jumping to any conclusions.

Depending on your symptoms, a proper diagnosis may be a fairly rapid process involving simple blood tests, or it may be more invasive, like requiring a biopsy.

Here are several medical conditions your healthcare provider may consider as alternative diagnoses to MS.

Common Misdiagnosis: Multiple Sclerosis

One of the most common answers to the question was multiple sclerosis . Both diagnoses have an effect on the central nervous system. These diagnoses also frequently cause muscle spasms, balance changes, tremor, and impaired memory. However, these are two separate diagnoses.

One difference is that MS is often diagnosed when someone is in their 20s, while most people receive a PD diagnosis in their 60s. Also, MS is an autoimmune disease that over time causes nerve damage. Parkinsons affects the brain. The brain starts producing less and less dopamine, which is responsible for controlling movement.

Yes, with MS which I was worried about for years, but right now I do not know which one is worse. However, my meds are helping a lot. My new saying is It is what it is, aka just live on. My neurologist says that I have stage one mild Parkinson’s disease.

My husband was diagnosed with MS back in 1993 when he had a mini stroke. He was diagnosed with Parkinsons in 2014.

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Fasciculations Induced By Systemic Diseases Drugs And/or Intoxication By Heavy Metals

Thyroid disorders such as hyperthyroidism and inappropriate secretion of thyrotropin syndrome can also trigger fasciculations. Similarly, hypophosphatemia and calcium disorders secondary to hyperparathyroidism can sometimes cause the same. With regard to pharmacological treatments, in a pioneering experimental study Wigiton and Masland concluded that neostigmine may cause fasciculations potentials by increasing the concentration of acetylcholine in the neuromuscular junction in felines. Discharges are caused by the direct effect of acetylcholine on motor nerve terminals. Moreover, due to a similar mechanism, the same occurs during the induction of anesthesia with succinylcholine by endotracheal tube.

Finelli described an interesting case under the title of Drug-Induced Creutzfeldt-Jakob-like Syndrome. An elderly manifested rapidly progressive dementia, postural tremor, gait instability, myoclonus and fasciculations caused by a combination of lithium and nortriptyline. Postural tremor, multifocal myoclonus, amyotrophy and fasciculations were also reported in a woman treated with topiramate for migraine without aura. Orsini et al. also presented a case of fasciculations caused by oral corticosteroids at immunosuppressive doses in patients with immune-mediated kidney disease.

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Parkinsons Disease Risk Factors

• Age: In most cases, people do not develop noticeable signs of Parkinsons disease until they are 60 or older. Only in about 10 percent of cases or less do people develop early onset Parkinsons disease .
• Gender: Men are twice as likely to develop Parkinsons than women. In addition, women tend to be on average two years older than men they develop PD.
• Family history: Around 15 percent of people with Parkinsons have a family member with this condition.
• Ethnicity: Hispanics and Caucasions have the highest incidence of Parkinsons disease while African Americans and Asians have the lowest incidence.

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The Effect Of Parkinsons Disease On Patients Undergoing Lumbar Spine Surgery

Jeffrey Gilligan

1Department of Neurosurgery, Icahn School of Medicine at Mount Sinai, New York, NY, USA

2Department of Neurosurgery, North Jersey Spine Group, Wayne, NJ, USA

3Department of Orthopaedics, Icahn School of Medicine at Mount Sinai, New York, NY, USA

Abstract

1. Introduction

Parkinsons disease is a neurodegenerative disorder characterized by resting tremors, rigidity, bradykinesia, postural instability, and gait disturbances . The prevalence of PD in industrialized countries is estimated at 0.3% of the entire population with approximately 7 million people affected worldwide . PD is an age-related disease which is rare before the age of 50, with a prevalence of about 1% in people over the age of 60 and up to 4% in people over the age of 80 .

PD is increasingly recognized as an important cause of spinal disorders requiring surgical intervention . However, spinal procedures can be complicated by underlying osteoporosis and severe musculoskeletal dysfunction in this population.

In this study, we investigate the effect of PD on patients undergoing lumbar spine surgery. The aim of this study is to identify the incidence, trend, risk factors, outcomes, and cost of lumbar spinal surgery for degenerative disease in PD patients.

2. Materials and Methods

2.1. Sample Selection

2.2. Outcome Measures

2.3. Data Analysis

No Institutional Board Review approval was required for this study.

3. Results

4. Discussion

5. Conclusion

Data Availability

Disclosure

Parkinson’s Misdiagnosis: Thyroid Issues

Thyroid issues affect muscle strength and can cause fatigue, muscle aches, stiffness, and joint pain. The early stages of Parkinsons could look similar to thyroid problems. However, with time and as a patient learns more about his or her own symptoms, they are able to provide a fuller picture, which can lead to a clearer diagnosis.

My husbands endocrinologist adjusted his thyroid medicine and was so surprised when he did not feel any better.

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Myopathy Associated Postural Deformity In Pd

Inflammatory myopathy of the paraspinal muscles can mimic the appearance of camptocormia in PD. Wunderlich et al.38 have described a 63-year-old man with PD in whom a camptocormia-like deformity developed. They noted hyperintensity within the paraspinal muscles and histopathological features consistent with myositis. The patient was treated with steroids and they noted marked improvement in forward flexion.

Myopathy with nemaline rods, end-stage myopathy with autophagic vacuoles, mitochondrial myopathy, and necrotizing myopathy have all been associated with camptocormia in patients with PD.15,25,30 Gydnia et al.15 have studied 19 consecutive muscle biopsies obtained in patients with PD and either camptocormia or dropped-head syndrome , finding abnormal muscle biopsies in all patients. Although MRI images were not abnormal in all patients, MR imaging generally showed fatty degeneration of the paravertebral musculature or neck extensor musculature in many of them. Electromyography was also generally consistent with myopathy changes.

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Parkinson’s Misdiagnosis: Pinched Nerve

Pinched nerves do affect your bodys ability to send internal messages. This usually causes joint pain and can lead to a lack of limb or joint mobility. However, this does not align with most other PD symptoms.

A pinched nerve in my neck.

My doctor said I had a pinched nerve and degenerative discs in my neck, which were causing my arm to basically not move. Then my driving foot started to not work. I grew tired of not getting answers, so went for an extensive stay at the Mayo Clinic and now have a great doctor at UCLA.

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Case : Bilateral Stn Dbs

This patient was a 59-year-old man with advanced idiopathic PD and motor fluctuations. Preoperatively it was noted that he had severe camptocormia . He underwent placement of bilateral STN deep brain stimulators and a right chest dual channel pulse generator. He was discharged to an acute rehabilitation facility on postoperative Day 6 in good condition for several weeks after his hospitalization. At 2-year follow-up, his gait and ease of ambulation had improved, but he had no significant improvement in his camptocormia posture .

Case 1. Preoperative image of patient with severe camptocormia prior to DBS , and postoperative image obtained after DBS at 24-month follow-up .

How Do Treatments Differ

MS treatments can ease your symptoms during an attack or slow down the diseaseâs effects on your body.

Steroids like prednisone calm the inflammation that damages your nerves.

Plasma exchange is another therapy if steroids donât work. Your doctor will use a machine to remove the plasma portion of your blood. The plasma gets mixed with a protein solution and put back into your body.

Some people with both diseases who take anti-inflammatory medicines like steroids see their Parkinsonâs symptoms get better.

Disease-modifying treatments slow down MS nerve damage and disability. They include:

Medications to treat Parkinsonâs either raise your dopamine levels or offer a substitute. They can ease Parkinsonâs symptoms like tremors. Over time, they may become less effective.

Medicines used to treat Parkinsonâs include:

Deep-brain stimulation is another treatment for Parkinsonâs. A doctor places electrodes into your brain. They send out electric pulses that ease symptoms in your body.

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How I Reversed My Parkinsons Disease Symptoms

Being diagnosed with Parkinsons disease is a life-altering event. Youre presented with all these drugs to take to help ward off the unpleasant symptoms but these drugs cause unwanted side effects.

Its not a no-win situation. You can manage and possibly reverse Parkinsons disease and live a full life.

Its time to find out what you can do to help your body deal with this disease naturally and effectively. Just keep reading.

Spinal Stenosis Treatment Options

An accurate diagnosis by a medical professional is necessary to determine the underlying cause of spinal stenosis. Depending on the cause and severity, your doctor may suggest nonsurgical treatments, such as physical therapy, pain-relieving medications, and/or activity modification. Sometimes, minimally invasive procedures, such as epidural steroid injections may be advised. Surgery is rarely advocated as the first-line treatment unless there are severe symptoms or neurologic deficits.

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