Parkinsons disease (Guidelines)

Key Points

• Refer suspected Parkinson’s disease (PD) patients early, before beginning treatment, to a clinician with relevant expertise, who should be involved in both initiation and ongoing monitoring of drug therapy.
• Therapy for PD should be multi-disciplinary; drug treatment is only one aspect
• 'Is this person at risk of developing delirium, and how will I reduce that risk?"

Drug treatment of PD aims to alleviate the symptoms whilst seeking to reduce the potential to develop dopaminergic complications.

Tremor generally responds poorly to most drugs. Expectations need to be created at the outset.

A clinician with expertise in PD should be involved in drug treatment decisions on the initiation and ongoing monitoring of therapy as the disease progresses. Drugs used in the treatment of PD are detailed in the Highland Formulary (see resources). 

*Domperidone is associated with a small increased risk of serious side-effects and is now contra-indicated in those with underlying cardiac conditions and other risk factors – see Gov Drug safety update (see resources) In patients with PD it is useful as an antiemetic and to treat orthostatic hypotension – please discuss with a specialist before discontinuing treatment and for further information see Association of British Neurologists (ABN) advice (see resources). 

It is vitally important that patients in hospital receive their PD medication at the correct time, even if this is outwith normal drug times; sudden changes in PD medication can lead to sudden, severe deterioration.

Symptom control in hospital relies on patients receiving medication at specific times to ensure:

• improvement in the patient’s quality of life
• prevention of deterioration in a patient’s condition which can result in slowness, stiffness, immobility, tremor and rigidity
• prevention of acute withdrawal of medication (which can result in acute adverse reactions)
• prevention of unnecessary extension in a patient’s hospital stay.

When patients with PD are admitted to hospital:

• refer to guidance Inpatient management of Parkinson’s including nil by mouth guidance (see resources) 
• the local Parkinson’s team should be informed by telephone
• where possible patients should self-administer their PD medication.

1. GP suspects PD and refers patient to Consultant.
2. Parkinson’s disease clinics held at Caithness General Hospital, Wick, Raigmore Hospital, Inverness and County Hospital, Invergordon and Fort William and in peripheral clinics, eg Skye. The PD service for patients from Argyll & Bute H&SCP is now delivered from GG&C. Patients under the age of 65 years with suspicion of PD should be referred to Neurology Outpatients Clinic, Raigmore Hospital.
3. Consultant discusses differential diagnosis, treatment options such as physiotherapy, speech and language therapy, occupational therapy and medication, and gives information on PD.