Parkinson's Disease

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Clinical Description

Parkinsonism is a syndrome characterized by tremor, rigidity, bradykinesia and postural disturbances. It may be primary, i.e., Parkinson's disease, or secondary, i.e., drug-induced or due to uncommon disorders that may initially resemble Parkinson's disease.

 

Treatment 

General Measures

  • Educate the patient on the condition. General supportive therapy and advice about lifestyle modification, physiotherapy, and occupational therapy.

The objective of treatment is to:

  • Minimize disabling symptoms,
  • promote functional abilities
  • prevent complications and avoid serious drug-induced side effects, and
  • exclude secondary forms.

Note: Set therapeutic targets so that the patient is functioning as well as possible.

 

PRIMARY PARKINSONISM

Bradykinesia, rigidity and postural disturbance:

  • Carbidopa/levodopa, 25/100 mg, oral, ½ tablet 8 hourly. Increase dose in consultation with a specialist.
  • If optimal control has not been achieved, consider an alternative diagnosis or changing to a drug containing a higher dose of levodopa: Carbidopa/levodopa 25/250 mg. Specialist initiated.

 

DRUG-INDUCED PARKINSONISM

  • Anticholinergics have a very small role in this setting and should be used with caution.
  • Anticholinergic agent, e.g.: Orphenadrine, oral, 50 mg 8 hourly.

Tremor only:

Consider anticholinergic agent, e.g.:

  • Orphenadrine, oral, 50mg 8 hourly. Increase gradually according to clinical response or maximum dose of 400mg daily
  • Usual dose: 150-250 mg q24h.

Acute dystonic reaction

  • Usually follows administration of dopamine antagonistic drug, e.g., Metoclopramide and Phenothiazines. Anticholinergic agent, e.g., Biperiden, IM/IV, 2 mg. Repeat as necessary.

REFERRAL

  • If there is no improvement or poor control with treatment.
  • Increasing on/off phenomenon.