Nose twitching not likely an early tell for Parkinson’s

DEAR DR. ROACH: I am a 70-year-old woman. My father had Parkinson’s disease in his mid-50s. I don’t know my father’s first symptom, but I do recall that Michael J. Fox said he noticed a twitching in his pinky finger.

Well, I have a twitching at the tip of my nose. Could that be a sign of Parkinson’s? My doctors tell me to hold out my arms, but I don’t have a twitch. What do you think? Can a Parkinson’s twitch be anywhere in your body, or just in your hands and feet? — F.M.

ANSWER: Nose twitching is very unlikely to be the first sign of Parkinson’s disease. The tremor in PD is almost always in a limb (current diagnostic criteria for PD from the Movement Disorder Society require that the tremor be in a limb). A classic PD tremor usually starts in one hand, is at the rate of about five movements per second and occurs at rest. Other symptoms early in PD include a generalized slowness of movement (called bradykinesia), rigidity and a predisposition to falls.

Nose twitching sounds to me like an involuntary muscle spasm. These can happen in literally any muscle of the body (the eyelid is a common one), and go by the general name of “dystonias.” This just means “abnormal movement.” The vast majority of patients I see with these have a very benign course, but occasionally they can be severe enough to affect quality of life. They often can be effectively treated with an injection of botulinum toxin, which will stop the spasm for months.

One question I ask my patients who come in with a particular concern is whether they are more interested in getting rid of the symptom or whether they are more concerned that the symptom may represent the first stage of a potentially serious medical issue.

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