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National Collaborating Centre for Chronic Conditions (UK). Parkinson's Disease: National Clinical Guideline for Diagnosis and Management in Primary and Secondary Care. London: Royal College of Physicians (UK); 2006. (NICE Clinical Guidelines, No. 35.)


It is almost 200 years since James Parkinson described the major symptoms of the disease that came to bear his name. Slowly but surely our understanding of the disease has improved and effective treatment has been developed, but Parkinson’s disease remains a huge challenge to those who suffer from it and to those involved in its management. In addition to the difficulties common to other disabling neurological conditions, the management of Parkinson’s disease must take into account the fact that the mainstay of pharmacological treatment, levodopa, can eventually produce dyskinesia and motor fluctuation. Furthermore, there are a number of agents besides levodopa that can help parkinsonian symptoms, and there is the enticing but unconfirmed prospect that other treatments might protect against worsening neurological disability. Thus, a considerable degree of judgement is required in tailoring individual therapy and in timing treatment initiation.

It is hoped that this guideline on Parkinson’s disease will be of considerable help to those involved at all levels in these difficult management decisions. The guideline has been produced using standard NICE methodology and is therefore based on a thorough search for best evidence. Because of the unique problems of Parkinson’s disease, converting this evidence into recommendations for treatment might have been problematic, but we have been fortunate in having a very experienced and able Guideline Development Group who have interpreted the scientific papers in the light of their considerable clinical experience. I am grateful to them for their hard work and for their expertise.

The guideline includes many recommendations on the use of different classes of pharmaceutical agent, but the recommendations singled out as being of key importance also stress other aspects of management. This is not a negative emphasis based on the problems associated with anti-parkinsonian drugs, but reflects the major role of non-pharmacological aspects of care in this disabling chronic condition. Diagnosis is particularly highlighted. This can be difficult, and while swift assessment by someone with appropriate expertise is important when suspicion of Parkinson’s disease first arises, so too is it vital to reconsider the diagnosis if atypical features develop later. The speed with which we have recommended that patients should be seen may seem aspirational, but reflects the importance the Development Group feel should be attached to this. Other key recommendations urge healthcare professionals to be aware throughout the course of the disease of the potential benefits of referral for specialist treatment such as physiotherapy, occupational or speech and language therapy. I would also commend to the reader the excellent section on communication, another area of particular difficulty in this disease.

One of the incidental benefits of producing an evidence-based guideline is that the process highlights those areas in which the evidence is particularly lacking. There are always more of these than we would wish. Towards the end of this document the Development Group has indicated those areas which they believe are particularly deserving of, and amenable to, further research efforts.

Two centuries since its first description, Parkinson’s disease remains a huge challenge. We hope that this guideline will not only aid current treatment of the disease, but will also stimulate efforts to improve future management more quickly than has been possible to date.

Dr B Higgins MD FRCP

Director, National Collaborating Centre for Chronic Conditions

Copyright © 2006, Royal College of Physicians of London.

All rights reserved. No part of this publication may be reproduced in any form (including photocopying or storing it in any medium by electronic means and whether or not transiently or incidentally to some other use of this publication) without the written permission of the copyright owner. Applications for the copyright owner’s written permission to reproduce any part of this publication should be addressed to the publisher.

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Cover of Parkinson's Disease
Parkinson's Disease: National Clinical Guideline for Diagnosis and Management in Primary and Secondary Care.
NICE Clinical Guidelines, No. 35.
National Collaborating Centre for Chronic Conditions (UK).

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