Complex PD - Motor Fluctuations

  • disabling dyskinesia
  • wearing off
  • "OFF" Period Freezing

Optimise Oral Medication

  • augment levodopa with:
    • rasagiline
    • entacapone
    • dopamine agonist

Tolcapone

  • refer patient to movement disorder team
  • patient counselling and consent
    • information sheet and blood test booklet provided
  • GP agreement for monitoring
    • shared care document provided
  • baseline bloods normal - FBC, U&E, LFT
  • initial prescriptions from specialist team
    • first three months
    • tolcapone 100 mg tds - can increase to 200 mg tds
  • fortnightly bloods via GP
  • if LFTs rise significantly - STOP immedietely
  • if no improvement in wearing off and freezing - DISCONTINUE

Apomorphine

  • refer patient to movement disorder team
  • patient counselling and consent
    • information sheet provided
  • GP agreement for support
    • shared care document provided
  • baseline bloods normal - FBC,ESR, Coomb’s test
  • day-case apomorphine trial
    • if required - domperidone 20 mg tds for 3 days pre-admission
  • initial prescriptions from specialist team
    • first 3 months
    • penject device or sc infusion pump
  • if no improvement in wearing off and freezing - discontinue

 

Surgical Options