PriMeD
Relax... you bring the coffee... we'll do the rest
Relax... you bring the coffee... we'll do the rest



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Management of early idiopathic Parkinson's disease (GLX-0005)
Australia does not have any guidelines regarding evidence based medicine or clinical pathways for managing Parkinson's disease. In this module, we take a look at the drug options available to you and our experts will provide guidance on the best use of medication. Through cases, you will make decisions regarding when to initiate medication and what medication to use. You will also learn about the stages people with Parkinson's disease commonly go through, as well as, the roles nurses and allied health professionals have in early treatment.

Learning Objectives:

  • Initiate pharmacological intervention in a patient with idiopathic Parkinson’s disease
  • Be aware of the role of a multi-disciplinary team in providing support for a patient with idiopathic Parkinson’s disease
  • Describe the major drugs and possible side effects of the drugs used in the treatment of idiopathic Parkinson’s disease
  • Identify the most suitable initial drug treatment for idiopathic Parkinson’s disease based on patient’s signs and symptoms
  • Be able to decide on the best time to commence drug treatment in patients with idiopathic Parkinson’s disease
  • Be able to initiate the most appropriate drug treatment for idiopathic Parkinson’s disease based on patient’s symptoms
  • Be aware of the importance of planning for the future and creating a support network for patients with idiopathic Parkinson’s disease
  • Identify strategies to assist in managing Parkinson's disease in a rural or remote community
  • Identify the challenges of managing Parkinson's disease in a rural or remote community
  • Describe the stages and progression of idiopathic Parkinson’s disease
This online training program has been developed by the Medeserv education team, in partnership with A/Prof Martin Krause and Parkinson’s Australia. Parkinson’s Australia is the national voice for Australians living with Parkinson’s disease. The organisation strives to ease the burden and find a cure through advocacy, education, support services and research.

This project was funded by the Commonwealth Department of Health and Ageing and John T Reid Charitable Trusts.

Disclaimer
Every endeavour is made to ensure the quality and currency of information contained in this educational program. However, at any point in time, some of the details included in this program may not be up to date (especially in regard to drug information). Further, by it's nature, this educational program does not make recommendations about the care of individual patients and cannot be interpreted as substituting for the professional's responsibility to make judgements in any instance of care using the most up to date information from multiple available sources.

Content author and expert presenter
Associate Professor Martin Krause

A/Prof Martin Krause A/Prof Martin Krause graduated in 1995 from the medical school of the Ruprecht-Karls University of Heidelberg in south-western Germany, one of the oldest faculties in the world (founded in the 14th century). He completed his medical training at the University Clinics of Heidelberg.

Dr Krause’s scientific interests are movement disorders especially Parkinson’s disease, dystonia, and tremor. In 1996 he joined the research group of Professor Volker Tronnier, who was one of the first stereotactic neurosurgeons in Germany to use Deep Brain Stimulation for the treatment of chronic pain and movement disorders. This research group was one of the first to prove Deep Brain Stimulation to be an effective treatment of generalized dystonia.

Dr Krause is a founding member of the German Parkinson Society. He participated in the German Competence Network of Parkinson’s disease and was involved in the development of the German therapeutic guidelines for Parkinson’s disease. In 2006, he joined the Westmead Movement Disorder Research Group for a sabbatical research program investigating the effect of deep brain lesions on motor behaviour. In September 2007, he accepted the appointment as Associate Professor of Neurology in the medical faculty of the University of Sydney at Nepean Clinical School. Dr Krause has published over 25 scientific articles in international medical journals including three articles in the New England Journal of Medicine.

Educators
Janine Roberts
Iain Packer

Education methodology and design
Professor Lynn Robinson
is Director of Education Innovation in the Centre for Health Innovations and Solutions, The University of Queensland.

Significant contributor and audience representative
Dr Natalie Burch (GP)

Dr Natalie Burch (B.Sc., M.B.B.S., DRANZCOG, FRACGP) works as a rural general practitioner in Scottsdale, Tasmania. Her special interests in medicine include mental health, family planning and low risk obstetrics, minor surgery and emergencies.

Expert presenters
Dr Victor Fung

Dr Victor Fung is Director of the Movement Disorders Unit, Department of Neurology, Westmead Hospital. He has a clinical and research interest in Parkinson’s disease and movement disorders. He is Vice-President of the Movement Disorder Society of Australia, and serves on the Executive and Educational Committees of the Asian & Oceanian Section of the international Movement Disorder Society and the Editorial Board of journal Movement Disorders. He was the founding Chairperson of the Movement Disorder Society of Australia Clinical Research and Trials Group from 2001-2007 and on the Management Board of Neuroscience Trials Australia from 2003-2007. He has been on the Scientific Advisory Committee of the Australian Brain Donor Program since 2004 and is a member of the Parkinson’s Australia’s Scientific Committee and Parkinson’s NSW Advisory Board.

Dr Michael Hayes
Staff specialist and consultant neurologist at Concord Hospital, Sydney, NSW.

Laraine McAnally
Laraine McAnally works as a Clinical Nurse Consultant in Parkinson’s disease and Epilepsy, at Westmead Hospital, Sydney. The Neurology Department at Westmead Hospital has a special interest in Movement Disorders, in particular Parkinson’s disease. Laraine has 22 years experience in Neurology nursing, with a post-grad in neuroscience and has specialised in Parkinson’s disease for the last 9 years. Her role incorporates assessment and management of people with Parkinson’s disease, both in the out patient and in patient setting, initiating patients on apomorphine therapy, performing levodopa challenges, being involved in the care and assessment of the surgical Parkinson’s disease patient undergoing Deep Brain Stimulation (DBS) and Duodpa therapy (SAS & Clinical trial). Laraine sees the main focus of her role to be in the management, support and education of the person with Parkinson’s disease and their carers and family to allow them the best quality of life.

Kate Schuj
Kate Schuj is a Senior Speech Pathologist with 8 years experience in Rehabilitation. One of her clinical specialties is Parkinson’s disease and she is currently a part of the Multidisciplinary Parkinson’s Disease Clinic at Concord Hospital in metropolitan Sydney.

Joan Perkins
Joan is a graduate physiotherapist from Sydney University with extensive experience in Neurology and Women's Health. She has been a senior physiotherapist in the Parkinson's Disease Clinic at Concord Hospital for the past 10 years, working with people with Parkinson’s disease and their carers. She also is a clinical consultant to other physiotherapists and doctors throughout NSW.

Acknowledgement
A sincere thank you to Professor John GL Morris for generously providing us with the use of his patient videos.
We gratefully acknowledge the patients who generously volunteered to be part of this project.

References
[1] Clarke CE. Parkinson’s disease. BMJ 2007;335:441-5.
[2] eTG complete. Neurology, Parkinson’s disease, Treatment of early Parkinson’s disease, Pharmacological Management. Melbourne: Therapeutic Guidelines Ltd; 2007. Viewed on 16/01/2009.
[3] Healthy Alliance. The Parkinson’s disease atlas. Hertfordshire: Mardeno; 2006.
[4] National Health Service (NHS) and Royal College of Physicians. Parkinson’s Disease: Diagnosis and Management in Primary and Secondary Care (NICE Guidelines). London: Royal College of Physicians; 2006. Viewed on 02/12/2008, at: http://www.nice.org.uk/nicemedia/pdf/cg035niceguideline.pdf
[5] Prepared by Access Economics for Parkinson’s Australia. Living with Parkinson’s Disease: Challenges and Positive Steps for the Future. Canberra: Access Economics Pty Ltd; 2007 Jun 18. Viewed on 06/11/2008, at: http://www.parkinsons.org.au/media-advocacy/docs/pd-study.pdf
[6] Rascol O, Brooks D, Korczyn AD, De Deyn PP, Clarke CE, Lang AE. A five-year study of the incidence of dyskinesia in patients with early Parkinson’s disease who were treated with Ropinirole or Levodopa. NEJM 2000;342:1484-91.
[7] Thomas A, Bonanni L, Di Iorio A, Varanese S, Anzellotti F, D’Andreagiovanni A, Stocchi F et al. End-of-dose deterioration in non ergolinic dopamine agonist monotherapy of Parkinson’s disease. Mov Dis 2005;21:343-53.
[8] The Parkinson Study Group. Levodopa and the Progression of Parkinson's Disease. NEJM 2004;351(24);2498-508.

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Time: 1 hour 30 minutes
Catalogued by:
  • Clinical knowledge and skills
    • Neurological conditions
  • Clinical continuum
    • Management
    • Therapeutics
  • Practice contexts
    • Metropolitan practice
    • Rural practice
    • Remote practice
  • Units by type
    • Learning material
  • RACGP Domains of General Practice
    • Applied professional knowledge and skills
  • ACRRM Educational Domains and Curriculum Areas of Rural & Remote Medicine
    • Rural and remote context (Domain)
    • Management (Area)

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