Neurologists publish guidelines on using videos for diagnosis
By Charlie Jolie
When diagnosing a movement disorder such as Parkinson’s disease, clinicians must rely on their own visual examination of the patient, because there is no blood test or brain scan to confirm the diagnosis. To diagnose and track the progress of these conditions, and to collaborate with other caregivers, neurologists who specialize in movement disorders rely often videotape these exams.
Capturing this visual information is crucially important to providing effective care, but until now there has been no standard protocol for videotaping patients with movement disorders. This shortcoming led two Rush University Medical Center neurologists to publish a set of videotaping guidelines, which will enable other specialists to make diagnoses earlier and more accurately and to evaluate treatment progress better.
The need for improved diagnosis and evaluation of movement disorders is considerable. Parkinson’s disease alone afflicts as many as 1 million people in the United States, and about 60,000 people in the U.S. are diagnosed with the each year with the chronic, progressive illness, which affects the body’s ability to control movement. Thousands of additional cases go undetected annually, according to the Parkinson’s disease foundation.
Drawing on an internationally recognized catalog
The guidelines build on a strong, longstanding foundation. Decades ago, neurologists at the Rush Parkinson’s Disease and Movement Disorders Program helped establish and test the criteria used to diagnose Parkinson’s disease and similar movement disorders. Now they’re extending that expertise using video technology.
“Rush has been using video long before others thought to do anything similar, and we’ve assembled one of the largest databases in the world of movement disorders. These videos are instantly recognizable at neurology meetings around the world because of our systematic approach,” says Brandon Barton, MD, MS.
An assistant professor of neurology, Barton collaborated with Deborah Hall, MD, PhD, an associate professor of neurology, to create Video Protocols and Techniques for Movement Disorders, which Oxford University Press published online in October. The extensive multimedia reference combines the authors’ detailed guidance in how to videotape examinations with videos providing examples of real-life interactions with patients.
Distinguishing harmless tics from symptoms of debilitating disease
Originating deep within the central nervous system, movement disorder occur when the normal exchange of neurological messages between the brain, nerves and muscles changes. When signals to and from motor areas are not transmitted precisely, people experience speech and coordination problems, as well as involuntary movements such as tremors, slowness, spasms or tics.
Of course, not every twitch or jolt is a sign of disease. Without a blood test or other biomarker to confirm that a hand tremor or facial tic is, in fact, a disease symptom, neurologists need to look for specific and often subtle visual patterns.
Videotaping patient examinations has become a needed tool, especially when conferring with colleagues or seeking second opinions. “No amount of words in a chart can convey as much useful information as the direct visualization of the patient.” Barton says. To help make that information as useful as possible, the protocols guide physicians through a full exam so they can best detect visual patterns and clues unique to one of many movement disorders.
‘Trembling limbs move ... without permission of the soul’
Modern medicine only is starting to understand the causes of movement disorders, and medical experts have been perplexed by movement disorders for centuries. One of the first descriptions of what is now known as Parkinson’s disease comes from history’s most celebrated expert on human form and function. In the 1500s, Leonardo da Vinci observed that some people simultaneously experience involuntary movements and a loss of control of intended movements.
“This appears clearly in paralytics,” he wrote, “whose trembling limbs move ... without permission of the soul; which soul with all its power cannot prevent these limbs from trembling.”
Three centuries later British surgeon and apothecary James Parkinson authored “An Essay on the Shaking Palsy,” which systematically described the conditions of patients with the disease that would come to be named for him. While Parkinson's disease is the most widely known movement disorder, Barton points out that there is a broad spectrum of diseases in that category.
These movement disorders range from the common though not fatal essential tremor to those classified as psychogenic because they are caused by an underlying stress or psychological condition, not a neurological disorder. Patients often can suffer from more than one disorder and, without a trained eye, misdiagnoses are too common.
Perhaps nearly important as an accurate diagnosis is an early one. There are no cures for these disorders, but the earlier they are diagnosed, the sooner they can be managed. The more expert eyes that are trained to spot movement disorders’ subtle visual clues, the more people who will have a chance of controlling their diseases before the diseases control them.