Bradykinesia + rest tremor / rigidity / postural instability. Causes: idiopathic Parkinson, drug-induced, atypical (MSA, PSP).
History taking
- • Asymmetric tremor, micrographia, hyposmia, REM sleep behaviour
- • Drug history: metoclopramide, antipsychotics
Examination
- • 4–6 Hz pill-rolling tremor, cogwheel rigidity, festinant gait
Red flags
- • Haemodynamic instability
- • Rapid deterioration
- • Severe pain or new neurological deficit
Differential diagnosis
- • See differentials section per chief complaint
Recommended investigations
- • CBC, basic metabolic panel as indicated
- • Targeted disease-specific tests
Diagnosis
- • Clinical diagnosis supported by targeted investigations
Initial treatment / management
- • Treat underlying cause
- • Symptomatic relief
- • Patient education
Drug therapy
- • Levodopa/carbidopa, rasagiline, pramipexole — usually initiated by neurology
Follow-up advice
- • Review in 2–4 weeks or earlier if worsening
- • Monitor response to therapy and adverse effects
Patient counselling
- • Explain diagnosis and natural course in lay terms
- • Red-flag symptoms warranting urgent return
- • Adherence to medications and follow-up
Referral criteria
- • Refer all suspected new cases to movement disorder clinic
References
- • Harrison's Principles of Internal Medicine, 21e
- • NICE / WHO guidelines (current edition)
Educational outpatient guide — verify against local guidelines before clinical use.
