Movement Disorders

Parkinson’s Disease
Dr. Mit Ankur Raval

Parkinson’s disease is a clinical neurological disorder in which bradykinesia is accompanied by characteristic motor features such as rigidity or rest tremor. Non-motor symptoms can be an important part of the illness.

Symptoms

Motor and non-motor features to know.

Motor symptoms

Slowness, stiffness, rest tremor in some patients, reduced arm swing, gait change, freezing or postural instability.

Non-motor symptoms

Sleep problems, constipation, autonomic symptoms, mood changes, pain and cognitive concerns can be clinically important.

Diagnosis

Diagnosis is primarily clinical. History, neurological examination and the overall pattern are central; tests are used selectively when another cause needs to be considered.

Treatment

Management may include medication, exercise/rehabilitation, speech/swallow support, non-motor symptom treatment and advanced therapies in selected patients.

When to review

Wearing-off, dyskinesia, increasing falls/freezing, new troublesome symptoms or increasing treatment complexity merit specialist review.

Urgent symptoms

Sudden weakness, speech difficulty, loss of consciousness or another abrupt neurological deficit requires emergency assessment.

Treatment pathway

Treatment evolves with the patient.

Early stage

Establish the diagnosis, optimise symptomatic therapy, encourage exercise and address non-motor symptoms.

Changing pattern

Review wearing-off, dyskinesia, gait problems, falls and treatment side effects.

Advanced disease

Consider whether advanced treatment pathways may offer meaningful benefit for selected symptoms.

Goals of care

Treatment decisions should reflect function, independence, quality of life and the patient’s priorities.

Patient questions

Patient questions

Does every tremor mean Parkinson’s disease?
No. Tremor has multiple causes and needs clinical characterisation.
Does DBS cure Parkinson’s disease?
No. DBS can improve selected symptoms in appropriately selected patients but does not cure the underlying disease.
Can non-motor symptoms be treated?
Yes. Sleep, mood, autonomic, cognitive and other non-motor symptoms should be actively assessed.
Selected clinical references: Movement Disorder Society and NICE Parkinson’s disease guidance. NICE
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Important: This website provides general information and is not a substitute for an in-person medical consultation. In an emergency, seek immediate medical care.
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