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SeetoMD Notes: Tremor and Parkinson’s Disease

(2026-04-10)

In neurology, tremor and Parkinson’s disease are very common.

Parkinson’s disease is common—but not simple.

Its cause is still not fully understood. Some people have a family history, but many do not.

This disease is not easy to diagnose.

An earlier European study showed that even experienced neurologists had only about a 70% diagnostic accuracy.

Why is it often misdiagnosed?

1. Tremor ≠ Parkinson’s disease
The first clinical question is:
Is the tremor present at rest? Or only when holding or lifting something?

2. Early symptoms are often atypical
Typical Parkinson’s features include:
    Unilateral tremor
    Slowness of movement
    Small-step gait, forward posture
    Handwriting becoming smaller (micrographia)

But not everyone presents with all symptoms at the beginning.

3. Patient descriptions can be biased
Some patients fear Parkinson’s and minimize symptoms. Others fear missing a diagnosis and exaggerate symptoms. So the “story” the doctor hears is not always fully accurate.

About DaTscan

In the past decade, a test called dopamine transporter imaging (DaTscan) has been used.
    Sensitivity: ~90%
    Specificity: ~90%

This means: About 10% of true Parkinson’s cases can still test negative. Some positive cases may respond poorly to medication

So DaTscan is a supporting tool, not a final judge.

My Clinical Approach

1. Don’t rush the diagnosis
Some diseases need time to reveal themselves.

2. Look at the pattern, not a single symptom
If a patient has:
    Tremor (especially unilateral)
     Slower walking
     Smaller handwriting
     Clumsiness

Then diagnostic confidence increases significantly.

3. Try to make things objective

I often recommend:
    1.    Finger tapping test
“Use your thumb and index finger. Open as wide as possible, then tap them together as fast as possible. Make each movement large—don’t make small motions.”
    2.    Video recording of gait
    3.    Compare over time

4. Look at medication response
If there is a clear response to Levodopa, diagnostic confidence increases significantly (approaching ~95%).

5. It’s not just tremor

Parkinson’s is not only a motor disorder. It may also include:
Constipation
 Dizziness
 Blood pressure instability
 Urinary issues
 Sleep problems

Often requires involvement of other specialties.

6. Treatment (briefly)

The core treatment remains dopamine replacement therapy (e.g., Levodopa).

Additionally: Deep Brain Stimulation (DBS) and surgery may be considered in selected patients. These are usually considered in the mid-stage of the disease, and outcomes can vary.