To the Editor I read with interest the Aminoff article1 on the future of the neurologic examination. I could not agree with him more and wish to share the perspective of one who relies on the findings of the neurologic examination on a daily basis.
As a practicing movement disorder neurologist who specializes in providing the diagnosis for and treating patients with Parkinson disease, atypical parkinsonism, and hyperkinetic movement disorders (eg, dystonia, myoclonus, chorea, and tics), the neurologic examination is indispensable. No imaging test supplants an expert examiner in diagnosing Parkinson disease, and for the other disorders listed, there is no specific test—the diagnosis is clinical. More importantly, evaluating the effectiveness of treatments rests completely on the clinical examination, with careful observation playing a crucial role. It is highly unlikely in our lifetime that we will see ancillary tests that are more reliable or faster than a skilled examiner at parsing out the phenomenology of patients with complex movement disorders. The careful neurologic examination of patients with movement disorders complements the many modern genetic and imaging studies that are all the rage. Only by understanding the phenomenology of the involuntary movements can we make sense of the complex genetics that underlie such disorders as parkinsonism, myoclonus, and dystonia.
Frucht SJ. Future of Neurologic Examination in Clinical Practice. JAMA Neurol. 2018;75(3):383–384. doi:10.1001/jamaneurol.2017.5001
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