For Differential Diagnosis In Patients With

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There is no single clinical neurophysiology test that can be used to distinguish with certitude between patients with APD at an individual level. This situation of clinical neurophysiology is common to many other conditions. In practicing clinical neurophysiology, the examiner is constantly looking for data that can bring more cues to confirm or refute an hypothesis made on the basis of clinical exam. The selection of tests useful for differential diagnosis in patients with APD can only be orientative or suggestive, but conclusive. One of the roles of those whose work is devoted to clinical neurophysiology should be to search for new methods and technical improvements to bring further understanding on pathophysiological mechanisms of the disease process.

From the author's point of view, the neurophysiological tests that better characterize parkinsonism and, specifically, the APDs, are listed in Table 4. Performance of ballistic movements within a reaction time task paradigm is useful to test the mechanisms of motor preparation and execution, even though very much should still be learned on the physiology of motor preparation for the test to provide its full potential of information. Brainstem and spinal reflexes have to be conveniently modulated by the descending motor commands for them to be integrated in the subject's normal motor behavior. Although many tests have given interesting information on the abnormal brainstem and spinal reflex modulation in patients with parkinsonism, a good clinical correlate of these abnormalities is still pending. The evaluation of autonomic reflexes and the sphincter EMG provides information on specific abnormalities that can be predominant in certain groups of patients. They reflect the involvement of specific groups of neurons, well correlated with pathologic findings. However, they are not useful for the diagnosis on an individual patient basis since similar abnormalities can be

Table 4

Selection of Neurophysiological Findings Allowing for Characterization of Specific Disorders Presenting With Parkinsonism

Table 4

Selection of Neurophysiological Findings Allowing for Characterization of Specific Disorders Presenting With Parkinsonism

Disorder

Results of Neurophysiological Tests

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