When an assessment makes sense
Parkinson's rarely announces itself with tremor. Relatives often notice other things first: that one arm no longer swings when walking, that handwriting has become smaller, that the voice sounds quieter or the face shows less expression.
Some complaints precede the movement symptoms by years:
- a declining sense of smell
- acting out dreams during sleep, often with talking, hitting or kicking
- persistent constipation without another explanation
- increasing stiffness in the shoulder or neck that does not respond to orthopaedic treatment
None of these signs on its own means that Parkinson's disease is present. If several occur together, or persist over a longer period, a neurological assessment is advisable.
How the diagnosis is made
The diagnosis is made clinically — through conversation and examination. What matters is slowed movement together with either muscle stiffness or tremor at rest.
Above all this takes time. I allow a full hour for a first consultation: for the history, for the physical examination, and to make sense of the findings you already have.
In unclear cases a nuclear medicine scan of dopamine metabolism (DaTSCAN) can help, as can an MRI to rule out other causes. I arrange these investigations where they will genuinely change the assessment, not as a matter of routine.
What is not Parkinson's matters just as much. Essential tremor, a drug-induced parkinsonian syndrome or an atypical parkinsonian syndrome require different treatment and take a different course.
Treatment
Parkinson's disease cannot yet be cured. The symptoms can, however, be treated well over many years, and treatment today is considerably more differentiated than it was a decade ago.
The central aim is to compensate for the missing dopamine. Which medication, at what dose and at what time of day, depends on age, on the pattern of symptoms and on the circumstances of daily life — an adjustment that needs revisiting regularly.
When the effect of tablets begins to fluctuate over the course of the day, continuous methods come into consideration. Pump therapy, which delivers the drug evenly, I set up and adjust myself. Where deep brain stimulation is a consideration, I discuss with you whether it makes sense and refer you to a specialist centre.
Equally important are the complaints that do not concern movement: sleep disturbance, blood pressure fluctuation, constipation, pain and changes in mood. These are often overlooked, yet they shape daily life at least as much.
Care over time
Parkinson's changes over the years, and treatment has to change with it. Regular reviews serve to adjust the therapy before symptoms begin to dictate everyday life.
Records from daily life help more than any snapshot taken at the practice. A movement diary kept over a few days shows when the effect wears off and where something can be improved. You will find a template among the documents to download.
Alongside medication, physiotherapy, speech therapy and regular physical activity have an established place. Where it is useful, I will put you in touch with colleagues.
Frequently asked
- Do I need a referral?
- No. As a private practitioner I can see you without a referral. Please still bring any previous findings you have — they save repeating investigations.
- How long does a first consultation take?
- One hour. I need that time for the history, the neurological examination and the discussion of findings.
- What should I bring?
- Your e-card, all previous findings and imaging, medical letters and an up-to-date list of your medication. If relatives have noticed changes, it is often helpful if they come along.
- Can I ask for a second opinion?
- Yes. If a diagnosis has already been made and you are unsure whether the treatment fits, a second opinion is a common and sensible step. Please bring the findings you have so far.