ParkinsonismTriad of

Rigidity Resting tremor Bradykinesia

Causes -Idiopathic PD-Drug induced-Vascular-Akinetic rigid syndromes

-Multiple systems atrophy-Progressive Supranuclear palsy-Dementia Lewy body-Corticobasal degeneration

Idiopathic Parkinson’s disease“Chronic progressive neurodegenerative disease characterised by loss of the dopaminergic cells of the substantia nigra”

Clinical diagnosis: investigations used to rule out other diseasesUnilateral, worse in upper limbs, good response to L-Dopa

Signs/symptoms-Tremor-Rigidity-Bradykinesia-Mask –like face-Festinating gait, loss arm swing, stooped posture, slow to initiate/turn, postural instability

Non-motor features:-Constipation/incontinence of urine-Sleep disturbance-Depression-Cognitive decline/dementia

Management:-MDT approach: physio, OT, SALT, nurse specialist, palliative care-Pharmacology: Dopamine agonists, L-DOPA, COMT-I, MAOB-I,

-SurgeryThallidotomy/pallidotomyDeep brain stimulationDuodopa: intrajejunal L-Dopa gel