Investigations & Diagnosis , Treatment Plan

Investigations & Diagnosis
Refer to secondary care if suspected

Treatment Plan

Motor symptoms:
• Levodopa
o Entacapone: adjunct with levodopa for motor complications o Amantadine: for uncontrolled dyskinesia
 Side effects: hallucinations, insomnia, dry mouth, nightmares o Subcutaneous apomorphine: advanced cases with freezing/severe dyskinesia
• MAO-B inhibitors: selegiline, rasagiline
• Oral dopamine agonists: pramipexole, ropinirole
• Transdermal dopamine agonists: rotigotine

Non-motor symptoms:

Constipation: domperidone (avoid prochlorperazine/metoclopramide) Pain: Standard MSK/neuropathic approach
• Sleep disturbance: Sleep hygiene, identify the underlying cause
• Orthostatic hypotension: midodrine (1st line), fludrocortisone (2nd line)
• Psychotic symptoms: quetiapine
• Dysphagia: Consider enteral feeding
• Sialorrhea: anticholinergics, botulinum toxin

Follow-up:
• Review every 6-12 months
• DVLA: Groups 1/2 can drive with an annual review