Multicausality as an Increase in the Latency Period for the Diagnosis of Parkinson's Disease in Primary Care: A Case Report
Authors: Riquelme-Heras Hector 
Published: May 2021

Background: Parkinson's disease was described for the first time by James Parkinson in 1817 in the trial "Shaking Palsy," and thus there is also evidence of this disease in the Indian medical system 4500 years ago, for the diagnosis and its management with Mucuna pruriens.Years later, it was subsequently determined to contain levodopa. Two types of manifestations of Parkinson's disease are currently known, such as motor and non-motor, the first being the one that usually leads to diagnosis. Success in this will depend on the skill of the primary care physician, the ability to recognize the first symptoms by the patient, and the health systems in the management of care for the timely referral. This work shows the comprehensive management of a patient who arrives at Primary Care services, presenting vague and specific symptoms. These symptoms were treated with medications or remedies in order to calm the condition temporarily. It is convenient to call the specific symptoms such as headache, nausea, pain, dizziness, tiredness and weakness, poor motivation, sadness, easy crying, and sleep disturbances; A large percentage go to their health centers for presenting motor alterations, many times identified by their relatives or by themselves and despite being recognized as something abnormal, many of them come when the tremor intervenes with the activities of daily life. At this point, the management of the disease would begin, making clear the importance of education for the population to attend abnormal situations on time and not in late stages, significantly improving the quality of life or the prognosis of the disease Parkinson's, as is the case that occurred in our institution; A 64-year-old female patient who presents with tremor in the fifth finger of the right hand, she mentions that it is more intense when there are apparently stress situations, hyposmia and sleep disturbances, going to different health centers where they were controlled the discomfort with essential medications, many of these not requiring a prescription, temporarily decreasing in intensity; This being the beginning of multi-causality for proper management from considering the first contact doctor as a resource manager with the use of diagnostic skills to recognize characteristic signs in early stages of the disease and the ability to maintain continuity with the patients and their families as a model of family system. Studies were determined that non-motor manifestations could appear months or years before they manifest as motor symptoms to give comprehensive management to patients from their first contact with the health centers closest to them. The diagnostic presumption and its referral to the neurology and timely treatment service, until evaluating the functionality and efficacy of health policies, avoiding the delay in pharmacological treatment and access to specific neuroimaging studies at any stage of the disease.

Objective: The objective of this report is to present a clinical case of a patient diagnosed with Parkinson's disease, from its management in the first contact medical services to have comprehensive management by a neurologist, thus in this way the period of latency to start treatment.

Methods: We present a clinical case of a 64-year-old patient who came to consultation due to a tremor in the fifth finger of the right hand.A review of her medical history is performed, and management by different specialties is identified, for mood disorders, insomnia, essential tremor in addition to allergic rhinitis, already with drug treatment with slight or no improvement. The patient underwent a neurological examination and imaging and laboratory studies. She was referred to the neurology service as soon as possible.

Result: After the interrogation and physical examination, the patient was referred to the Neurology service to confirm the presumption of diagnosis as a movement disorder under study. This process is often called the "latency period" of the diagnosis. The present work is shown as a decisive factor in giving a verdict on this problem. It is known that this level of resolution takes into account the pillars of first contact medicine as health resource managers. In this way, pharmacological treatment was started with a decrease in tremor as a motor symptom and an increase in quality and amount of sleep, increased mood, and affect as non-motor symptoms.

Conclusion: The patient is under established medical and pharmacological control, and the long diagnostic latency period could be evidenced, as it usually happens in many movement disorders or their early stages, in this case, Parkinson's disease. Likewise, the family doctor is an instrument that allows the resolution of more than 90% of health problems in general, and the proper management of the remaining percentage is multifactorial, as well as medical skill and experience, the capacity of the patient or the family members. in recognizing early-stage motor disorders and health systems that often make a referral to other medical specialties difficult.