Refer all suspected Parkinson's

GPs should refer all suspected cases of Parkinson's disease to specialists rather than initiating treatment themselves, according to NICE.

The final NICE clinical guideline on Parkinson's disease, issued this week, also states that GPs need to start commissioning specialist services for Parkinson's, including physiotherapy, occupational therapy, speech and language therapy and palliative care.

Patients thought to have early Parkinson's disease should be seen by an expert for diagnosis within six weeks, with a referral time of two weeks recommended for those with signs of later stage disease or complications.

Patients with Parkinson's disease should have their diagnosis reviewed every six to 12 months.

The NICE guidance advises GPs to suspect the condition in people with tremor, stiffness, slowness and balance problems.

But it warns that essential tremor, which can develop with age, can be misdiagnosed as Parkinson's disease, as can the effects of multiple mini-strokes. A recent study from North Wales suggested that the error rate of community-based diagnosis was almost 50 per cent.

A first-line drug treatment for Parkinson's disease was not stipulated in the guideline, as there is no strong evidence base for which classes of drugs are best in different stages of the disease.

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