Ongoing care for Parkinson's disease, characterized by tremor, bradykinesia, and rigidity. Visits cover medication adjustment, management of motor fluctuations, and DBS evaluation when appropriate.
Indication
- Resting tremor (often starting on one side)
- Bradykinesia (slowed movement) and rigidity (muscle stiffness)
- Postural instability and falls
- Smaller handwriting (micrographia) and reduced facial expression
- Assessment of treatment response and dose adjustment
- Management of motor fluctuations (on-off) and dyskinesias
- Differential diagnosis from atypical parkinsonian syndromes
Preparation
- List of current medications and dosing times
- Symptom diary (on-off periods, tremor frequency)
- Bring previous MRI scans and neurology reports
- Be ready to discuss accompanying depression, sleep, and bladder symptoms
How it's performed
- Scoring of motor and non-motor symptoms with the UPDRS scale
- Brain MRI to rule out structural pathology
- Gold-standard therapy: levodopa + carbidopa (Sinemet)
- Dopamine agonists (pramipexole, ropinirole) as an early-stage option
- MAO-B inhibitors (rasagiline, selegiline) may be added
- Evaluation for deep brain stimulation (DBS) in advanced motor fluctuations
Post-procedure
- Outpatient follow-up every 3-6 months
- Dynamic adjustment of medication doses and timing
- Physical therapy, balance exercises, and fall prevention
- Cognitive and mood assessment (depression, dementia)
- Speech therapy (LSVT-LOUD) and swallowing evaluation
Risks
- Long-term levodopa use can cause dyskinesias (involuntary movements)
- Dopamine agonists may lead to impulse control disorders (gambling, shopping)
- Postural hypotension, nausea, and somnolence
- Risk of infection and bleeding with DBS surgery (about 1-3%)
- The progressive nature of the disease (treatment provides symptom control)
FAQ
Does Parkinson's treatment stop the disease?
Current treatments significantly relieve symptoms, but no proven therapy yet halts the progression of the disease.
Who is a candidate for DBS?
It is offered to selected patients who respond to levodopa but develop motor fluctuations and dyskinesias and do not have significant cognitive problems, after assessment by a multidisciplinary team.
Is exercise helpful?
Yes. Regular aerobic, balance, and flexibility exercises help with both motor and non-motor symptoms.
Does tremor always mean Parkinson's disease?
No. Essential tremor and other causes can also produce tremor. A detailed neurological examination is needed to make the distinction.
Related Information
Related Medical Services
Other services in the same specialty or with similar indications you may want to explore.
Dementia/Alzheimer's Evaluation
Neurology
Dementia/Alzheimer's evaluation — MMSE/MoCA, imaging, and amyloid PET/CSF tau biomarkers.
Multiple Sclerosis Follow-Up
Neurology
Multiple sclerosis (MS) follow-up — interferon, glatiramer, oral DMTs and B-cell therapies in RRMS.
Epilepsy Diagnosis and Treatment
Neurology
Epilepsy diagnosis and treatment — determining the seizure type and managing antiepileptic medications.
Stroke assessment
Neurology
Stroke (cerebrovascular accident) emergency assessment — critical 4.5-hour window for tPA, 24-hour window for thrombectomy.
Neurological Examination and Assessment
Neurology
Neurological examination and assessment — a systematic clinical evaluation of the brain, spinal cord, nerves, and muscle system.
Sleep disorders evaluation
Neurology
Sleep disorders evaluation — comprehensive diagnosis for snoring, sleep apnea, and daytime sleepiness.
Electroencephalography
Neurology
Electroencephalography (EEG) — painless surface recording of the brain's electrical activity.
Nerve Conduction Study
Neurology
Nerve conduction study — non-invasive measurement of conduction velocity and signal amplitude in peripheral nerves.