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Parkinsonism and Movement Disorders

 

Parkinsonism is a syndrome of:

  • hypokinesia (poverty of movement) / bradykinesia (slowness of movement)
  • muscular rigidity - increased tone
  • rest tremor - frequency of 4-6 Hz
  • gait instability

Non-motor symptoms are wide ranging and can include depression, dementia, sleep disturbance, and autonomic disturbances (incontinence, dysphagia, constipation, impotence, hypotension and sweating) 

Main message is careful history and examination  

There are no laboratory tests or easily available imaging tests in primary care to help make the diagnosis. DAT scanning is now available in secondary care for specific indications. 

The NICE Guideline on the diagnosis and management of Parkinson’s says referral time should be no more than six weeks and should not exceed two weeks in cases where the condition is severe or complex. 

Referral: to either Neurology-as Parkinsons/Movement Disorder (any age) or Parkinsons Disease Clinic (linked with Care of the Elderly so useful for holistic care,co-morbidities,social issues) as in local Map of Medicine guidelines under Parkinsons Disease.

Consider Parkinsons Nurse Clinic for follow up/patient support as OPD or domicillary visit.

Note: differential diagnoses of parkinsonism includes;

  • Parkinson’s disease
  • Alzheimer’s disease –early in disease dementia develops
  • multiple cerebral infarction
  • drug-induced parkinsonism e.g. phenothiazines,metoclopramide
  • other degenerative parkinsonian syndromes
  • essential tremor
  • hydrocephalus
  • trauma - 'punch drunk' syndrome
  • Wilson's disease

 Ref:NICE ,Map of Medicine