A 75-year-old banker presents with complaints of increasing difficulty doing up his shi buttons every morning and brushing his teeth. On examination dental hygiene is good and you notice that his hand shakes slightly when he is relaxing in front of the TV but stops when he reaches for the TV remote, and he is able to switch channels. What is the best initial management step?
The presentation is of relaxing/resting tremors which disappears on reaching for the remote. He is suffering from parkinson disease. Levodopa remains the most effective symptomatic treatment for PD and the gold standard against which new therapies are compared. No current medical or surgical treatment provides antiparkinsonian benefits superior to what can be achieved withlevodopa.
Deep brain stimulation
Send him for Cognitive Behaviour Therapy (CBT)
Prescribe L-Dopa
Prescribe Pramipexole
Parkinsonism and other movement disorders