In this next episode in the movement disorders and Parkinson’s disease series, we begin with a brief overview of the mechanisms of action of the medications used to treat Parkinson’s disease, before focusing on five common and important ward dilemmas encountered in the management of patients with Parkinson’s disease: (1) the patient is unable to take their oral antiparkinsonian medications, (2) the patient is psychotic or delirious, (3) the patient has autonomic instability/dysregulation with orthostatic hypotension +/- supine nocturnal hypertension, (4) the patient is frozen/in an ‘off’ crisis, and (5) the much-feared Parkinson-hyperpyrexia syndrome. We discuss pragmatic ways to tackle each of these problems, coloured with analogies and detailed explanations to make the content understandable in a structured manner (and hopefully also memorable!). This episode is suitable for anyone caring for patients with Parkinson’s disease, although it should be especially useful for junior doctors covering the wards on evening/night and weekend shifts (and medical students also about to find themselves in this position)!

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We’re thrilled to announce the first episode in our movement disorders & Parkinson’s disease series (also continuing our clinical method series), beginning with a discussion of how to perform an extrapyramidal examination, particularly in the context of suspected Parkinson’s disease, progressive supranuclear palsy (PSP), multiple system atrophy (MSA), corticobasal degeneration (CBD; or corticobasal syndrome, CBS), dementia with Lewy bodies (DLB) and normal pressure hydrocephalus (NPH), as well as assessing treatment responses to levodopa and other Parkinsonian therapies to distinguish an excessively ‘on’ or dyskinetic state, from a ‘good on’ state, from an ‘off’ state including a frozen state. As always in Riisfeldt Neurology Education, we provide a clinical focus to help contextualise the information, peppered with tips and tricks to optimise your examination techniques, and hopefully providing a structure to your learning, along with helpful mnemonics in order to aid memorisation. This episode is appropriate for medical students, junior doctors, physician and neurology trainees, and general practitioners (family doctors) and emergency physicians and their respective trainees, and any other health professional assessing patients presenting with extrapyramidal symptoms and signs or with a pre-established diagnosis such as Parkinson’s disease.

#meded #doctor #parkinsonsdisease #clinicalskills #rneurologyeducation