MEDICAL SPOTLIGHT: ‘Game-Changer’ Tool Changes Parkinson’s Treatment Path

'The improvement was radical'

Robert Sorger’s essential tremor diagnosis was not totally unexpected. His mother had it. His grandmother, too. But until a Health First Neurologist ordered up a DaTscan test, he had no family history of Parkinson’s disease.

BREVARD COUNTY, FLORIDA – Robert Sorger of West Melbourne arrived at Health First Neurologist Dr. Carlos Berrios Rosado’s office last year with a case of essential tremor that was literally out of control.

His right hand bounced violently in the air, and his previous neurologist had prescribed a veritable crayon box-sized regimen of drugs, but still nothing worked. He was adamant about his essential tremor diagnosis, “to the point of being belligerent about it.”

“My mom had it. Her mom had it. It runs in the family, and it’s a natural thing to think,” Robert says.

Essential tremor is commonly mistaken for Parkinson’s disease. They have similar symptoms – swinging and shaking, typically of the head, hands, arms and legs – but a very different etiology.

Dr. Berrios Rosado knew that, when it comes to Parkinson’s, a diagnosis that could be essential tremor no longer had to suffice. He knew Robert could definitively rule out (or in) Parkinson’s with something called a DaTscan test.

“Sometimes you can’t determine Parkinson’s from essential tremor,” says Dr. Berrios-Rosado. “This test has really changed the game.”

DaTscan is a contrast liquid that’s introduced into the bloodstream. As it circulates through the body, it makes its way to the brain, where it attaches to a molecule found on dopamine neurons.

A scan picks it up, and in a healthy brain, the dopamine neurons in a part of the brain called the striatum light up like long lobes, but Parkinson’s patients have an unhealthy dopamine system that is shrunken and dimmer.

Improvement Was Radical

In Robert’s case, his test came back conclusive for Parkinson’s. His previous course of treatments – high doses of the drug primidone – weren’t helping because they weren’t aiding the dopamine network in his brain. With the correct diagnosis, he was able to begin a course of therapy that changed his life.

“Lo and behold, in less than a month’s time, the tremors were virtually gone,” he says. “The improvement was radical.”
When essential tremors can be excluded, the treatment for Parkinson’s is targeted and impressive.

“If you have the right diagnosis, it’s a totally different treatment. OK, this person has a tremor, but their medication isn’t effective. They’re not necessarily improving. They might have a little reduction, but it gets worse over time. We do the DaTscan. It comes back positive. We take them off all the anticonvulsants and start them on the dopamine medication. They really have a better quality of life.”

Robert credits Dr. Berrios Rosado with “going the extra mile.” More than this, “he sensed my skepticism,” and gave Robert a route that not only expanded his understanding but gave him tremendous hope.

After all, “My mom had Parkinson’s, it turns out, and she lived until she was 94. If I get close to that I’ll be happy.”

To learn more about the Neurosciences program at Health First, visit HF.org/neuro.

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