20th July 2023

Management

Medication

Before commencing treatment, the extent to which a patient’s symptoms are affecting their life should be ascertained. High risk of poly-pharmacy, goals of care and side effects of medications should be established. Dopamine receptor agonists, particularly in those with pre-existing impulse control disorders, history of alcohol or smoking should be used with caution, as this can cause these disorders to relapse.

Medication should not be withdrawn suddenly as this can cause acute akinesia or neuroleptic malignant syndrome. Timing of medication administration is integral to maintaining optimum control. It is important to ensure these medications remain on the same schedule whilst a patient is admitted. Common medications are shown in Table 2.

Table 2: Medications used in the management of Parkinson’s Disease

Other medications can be used to treat non-motor symptoms, such as modafinil for excessive daytime sleepiness and midodrine for postural hypotension.

Palliative Care

Important to involve palliative care and have early discussions of advanced care planning. Providing written and verbal information regarding progression and advanced care planning is also helpful to the patient, especially for decisions regarding artificial feeding. This helps patients make advanced directives.

Other

Other members of the MDT are important to involve, such as physiotherapists and occupational therapists, to ensure patients can safely mobilise and manage at home. Speech and language therapists can support with hypophonia and dysphagia.