Parkinson’s Disease

Parkinson’s Disease

Subtle Symptoms

A slowly progressive disorder of older adults; often (but not always) starting with tremor, stiffness and slowness in one arm.

There is no Diagnostic Test and the diagnosis is a clinical one. The early symptoms can be subtle (e.g. writing difficulty, frozen shoulder, arm pain, loss of manual dexterity, mood change, sleep disturbance, general slowing down and in older patients may be merely attributed to ‘getting older’).

Not all patients have tremor. Sometimes blood tests and scans are done to exclude other diagnoses.

Accurate Diagnosis 

Many patients with tremors do not have Parkinson’s disease and Dopamine Scans (DAT) can be helpful in differentiating these cases. We are fortunate in Sussex to have ready access to this Specialised Test, which is performed in the Nuclear Medicine Department at the Royal Sussex County Hospital.

Some conditions can present with features of Parkinson’s disease but are due to different pathological processes. These are rare and are collectively termed ‘Atypical Parkinsonian’ Disorders.

It is important to try and distinguish patients with these conditions as the management, prognosis and response to drug treatment is different.

Drug Treatment

For the majority of patients with ‘Typical Parkinson’s disease’ (as opposed to ‘Atypical Parkinson’s Disease’ – see above) the initial response to medication is very good. There are many classes of drugs available to treat the symptoms of Parkinson’s Disease.


There is no universal first choice of drug and the decision of when to treat and with what drug must be done on an individual basis guided by either a Consultant with experience in treating patients with Parkinson’s Disease and/or a Specialist Nurse.


The speed of progression of the illness, response to drug therapy and side effects experienced will vary from patient to patient. One needs to also take into account individual lifestyle factors/occupation /hobbies and other medical conditions.

Some of the drugs are more likely to lead to longer-term complications in treatment response (‘Motor Fluctuations’) and sometimes there is a trade off between immediate relief of symptoms vs avoiding longer term complications.

Review and Care

Sadly, to date, none of the available drugs halts the underlying disease progressing and thus patients will need regular reviews of their medication requirements.

We are fortunate to have a number of Consultants with a specialist interest in Parkinson’s disease, both in Neurology and Elderly Care. The Community Care of patients is supervised by our three Parkinson’s Disease Nurses. Together we have formed a ‘Parkinson’s Disease Collaborative Group’ to share our collective skills and expertise for the benefit of patients.

Beyond Conventional Drug Treatment 

There have been many advances in the field of Parkinson’s disease with a number of new therapies currently undergoing evaluation in clinical trials. For example, recent treatment advances deliver medication by alternative routes – Patch Technology and Duodopa and the importance of physical activities/exercise.

Given the local expertise available, we are able to offer all of these treatments and are working closely with local GPs’ to develop guidelines for care of these patients.

National Network

I also have strong established links with the major centres in London allowing patients access to Specialised Treatments such as Parkinson’s disease Surgery (Deep Brain Stimulation) as well as providing local access to national clinical trials/research in Parkinson’s disease and related disorders (as part of DenDron- Dementia Research Networks).

Comprehensive Care

It is being increasingly recognised that patients with Parkinson’s disease have many symptoms beyond the problems with movement – so called ‘Non-Motor Symptoms’ (for example mood, sleep, mental faculties, fatigue, imbalance, speech, sexual and bladder/bowel function, isolation).

Many of these problems significantly impact on Quality of Life and with the team approach offered we hope we can go some way towards providing comprehensive care for local patients with Parkinson’s disease. In Brighton and Sussex NHS Trust we have a dedicated team of specialists with an interest in Parkinson’s disease. Not just Doctors and Nurses but also Neurophysiotherapists, Speech and Language Therapists, Neuropsychologists and we also have strong links to the Community Rehabilitation, Palliative Care and Mental Health Teams to provide support for patients and carers through all stages of the disease.

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