Roy G Beran
Consultant Neurologist, Australia
Scientific Tracks Abstracts: J Neuro Neurophysiol
As an adult neurologist, one is often asked to consult on geriatric patients who were admitted to hospital because a fall, without obvious cause, and it has become almost an axiomatic observation that many, possibly most, of these, if properly examined, have unequivocal definite features of Parkinson??s disease. When this is pointed out to you house officers or registrars, prior to seeing the patient, the response is one of incredulity and disbelief in which the young doctor disputes the diagnosis have claims to have looked for it but not found it. The antemortem diagnosis of Parkinson?? disease is an inexact clinical diagnosis based on the findings of at least 3 out of the following 4 clinical features, namely bradykinesia, rigidity, gait disturbance and tremor. It is very uncommon to have a geriatric patient who presents to hospital, due to unexplained falls, who is not bradykinetic. It follows that to complete the diagnosis it is necessary to confirm the presence of 2 of the remaining 3 features. To explore the presence of rigidity it is imperative to appreciate that the increased tone is ???increased resting tone?? and hence must be examine with the patient distracted because anything less does NOT represent ??resting tone?. This appears something that young doctors fail to appreciate. Once this has been confirmed, the next step is have the patient walk and the usual finding, in early Parkinson??s disease, is a stooped posture, something that is common in geriatric patients, often compounded by a failure to swing one or other arm while walking. This provided the triad of symptom to confirm the diagnosis. These features are complemented by the presents of grasp responses, if properly sought, palmar-mental responses and a positive glabella tap. With this combination, the next step is to trial a very small dosage of L-dopa, in the form of L-dopa/ carbidopar or L-dopa/benserazide, at a dosage of 100/25, ½ BID and to monitor the effects thereof.
Roy G. Beran is a consultant neurologist and accredited sleep physician, His qualifications include: MBBS, MD, FRACP, FRACGP, Grad. Dip. Tertiary Ed., Grad. Dip. Further Ed., FAFPHM, FACLM, FRCP, FANZAN, FAAN, FACBS, B Leg. S, MHL, FRSN, FSASS and FFFLM (Hon). Registration with the Australian Health Practitioner Regulation Agency (AHPRA) includes: Neurology; Public Health; and Sleep Medicine. He was a Designated Medical Examiner for the Civil Aviation Safety Authority, a medical assessor for Dispute Resolution for the State Insurance Regulatory Authority and an assessor for the Workers Compensation Commission of New South Wales (NSW).
