Parkinson’s disease is a disorder of the central nervous system that affects movements associated with degeneration of the basal ganglia and decrease in central dopamine levels. The three main symptoms of Parkinson’s disease are; involuntary shaking of parts of the body (tremor), slow movement, stiff and inflexible muscles.
Medications:
- If no functional disability – Tab. Relgin 1 (Rasagiline 1 mg) 1 tablet per day.
- If mild functional disability – Add tab. Amantrel (Amantadine 100 mg) 1 tablet once a day for 1 week. Later increase this to twice a day.
- If moderate functional disability – Add tab. Tidomet Plus (Levodopa 100 mg, Carbidopa 25 mg) 1 tablet thrice a day. Gradually increase on a fortnightly basis till 3 tablets thrice a day.
- For tremors – Tab. Pacitane (Trihexyphenidyl 1 mg) 1 tablet per day. Gradually increase the dose till 15 mg per day in 3 – 4 divided doses. Elderly patients can be sensitive to the medicine and can get confused. The dose needs to be tapered slowly once symptoms are controlled.
General advice:
- Physiotherapy to improve movement.
- Speech and language therapy to reduce voice tremors.
- Diet advice – to drink plenty of fluids to avoid constipation.
- Eating small frequent meals and adequate salt intake can prevent dizziness and postural hypotension.
Investigations:
- ECG – to rule out arrhythmias.
- Serum creatinine – to rule out renal impairment.
- Liver function test – to rule out liver impairment.
Referral:
Consider referral to neurologist if patient fails to respond or if presents with additional complications.