Clin Med
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Although motor fluctuation can often be severe in Parkinson's disease (PD), it is rare for an 'off period' to result in coma. The case presented here is of a patient with longstanding PD who was admitted to our hospital with a Glasgow Coma Scale of three after missing just one or two doses of her medication. ⋯ This case highlights how florid the presentation of motor fluctuations in PD can be and the importance of restarting treatment as quickly as possible. Guidance is provided on how to administer dopaminergic medications in patients who are unable to swallow.
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This concise guidance comprises a distillation of recommendations for the diagnosis and management of epilepsies for non-specialists and is based on updated clinical guideline 137 published by the National Institute of Health and Care Excellence (NICE). It is intended to provide the generalist at the front line (particularly but not exclusively in the acute hospital setting) with an accessible and up-to-date outline of key guidance on assessment, clinical management, communication and referral. Recommendations abstracted verbatim from the guideline are highlighted. Brief explanatory or supporting comment is given where appropriate.