Abstract

Parkinson’s disease is the most treatable of the neurodegenerative diseases, but the treatment tends to get more difficult with time. One problem is solved only for another to emerge. Even the greatest therapeutic enthusiast must admit to occasions where he or she reaches for the prescription pad with a faint feeling of foreboding.

Derek is a 58-year-old, well-educated and professional man, who has had Parkinson’s disease for 15 years. He came to his local neurology clinic because he was no longer able to travel to the more distant specialist centre that had managed his illness over recent years. He was agitated and confused, and unable to give a coherent history. He spoke of frequent ‘off periods’. He showed me his pills and claimed to be taking one or two cobeneldopa 25/100 mg and benzhexol 2 mg every waking hour and whenever he awoke at night, ropinirole 3 mg and baclofen