RESEARCH: The accuracy of diagnosis of parkinsonian syndromes in a specialist movement disorder service.

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Brain 2002 Apr;125(Pt 4):861-70

The accuracy of diagnosis of parkinsonian syndromes in

a specialist movement disorder service.

AJ, SE, Ben-Shlomo Y, Lees AJ.

The United Kingdom Parkinson's Disease Society Brain

Research Centre, Institute of Neurology, London,

Department of Social Medicine, University of Bristol,

Bristol, UK and Neurology Department, Austin and

Repatriation Medical Centre, Melbourne, Australia.

We have reviewed the clinical and pathological

diagnoses of 143 cases of parkinsonism seen by

neurologists associated with the movement disorders

service at The National Hospital for Neurology and

Neurosurgery in London who came to neuropathological

examination at the United Kingdom Parkinson's Disease

Society Brain Research Centre, over a 10-year period

between 1990 and the end of 1999. Seventy-three (47

male, 26 female) cases were diagnosed as having

idiopathic Parkinson's disease (IPD) and 70 (42 male,

28 female) as having another parkinsonian syndrome.

The positive predictive value of the clinical

diagnosis for the whole group was 85.3%, with 122

cases correctly clinically diagnosed. The positive

predictive value of the clinical diagnosis of IPD was

extremely high, at 98.6% (72 out of 73), while for the

other parkinsonian syndromes it was 71.4% (50 out of

70). The positive predictive values of a clinical

diagnosis of multiple system atrophy (MSA) and

progressive supranuclear palsy (PSP) were 85.7 (30 out

of 35) and 80% (16 out of 20), respectively. The

sensitivity for IPD was 91.1%, due to seven

false-negative cases, with 72 of the 79 pathologically

established cases being diagnosed in life. For MSA,

the sensitivity was 88.2% (30 out of 34), and for PSP

it was 84.2% (16 out of 19). The diagnostic accuracy

for IPD, MSA and PSP was higher than most previous

prospective clinicopathological series and studies

using the retrospective application of clinical

diagnostic criteria. The seven false-negative cases of

IPD suggest a broader clinical picture of disease than

previously thought acceptable. This study implies that

neurologists with particular expertise in the field of

movement disorders may be using a method of pattern

recognition for diagnosis which goes beyond that

inherent in any formal set of diagnostic criteria.

PMID: 11912118 [PubMed - in process]

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Pam and all,

I think this is the key:

This study implies that

neurologists with particular expertise in the field of

movement disorders may be using a method of pattern

recognition for diagnosis which goes beyond that

inherent in any formal set of diagnostic criteria.

There is still about a 10-15% chance of error even if you go the the

top people however. So diagnosing a brain disorder is still not an

exact science. It is getting better, but they only settled on a common

name for it in 1995 and not everyone uses that name even today.

I spoke to someone last night who was diagnosed as Shy-Drager Syndrome

less than two years ago by a neuro who had worked with Dr. on at

Vanderbilt - yet the most prevalent features are balance problems as much

as OH, no tremor and little response to levodopa or agonists. I would

tend to use SDS only if OH was the major problem and little else showing

up - of course then you could call it PAF also. Maybe PD+ is the

way to go.

Take care, Bill