Early referral to physiotherapy and occupational therapy to help maintain independence for as long as possible.

All parkinsonian patients should have a slow uptitration L-dopa trial to at least 1 g a day for 3 months.

Down-titrate L-dopa medication when/if it is no longer perceived to be effective, but reinstate the last dose if there is a deterioration.

In patients with orthostatic hypotension, consider simultaneous midodrine if there are at least 4 hourly intervals between L-dopa doses.

Modified release L-dopa can help nocturnal symptoms but be cautious about nocturnal hypotension, in particular in those with nocturia and mobility issues.

There is no proven effective pharmacotherapy for this.

Early referrals to physiotherapy and occupational therapy.

Review medications and stop unnecessary muscle relaxants or daytime sedatives, to help balance.

Look for and treat concomitant reversible causes of vertigo.

Early referrals to physiotherapy and occupational therapy .

Consider DEXA scanning and FRAX score calculation and manage for osteoporosis

Determine whether dystonia is secondary to levodopa-induced dyskinesia (ie, increases at peak dose); if so adjust medication accordingly

Treatment naïve/wearing off dystonia may respond to levodopa.

Focal dystonia can respond to botulinum toxin injections, while generalised dystonia may respond to clonazepam 0.5–1 mg or baclofen 5 mg three times a day. This should be done in conjunction with physiotherapy for splinting

Anticholinergics can be tried, but autonomic adverse effects may limit their use.

Physiotherapy referral for stretching and splinting alongside botulinum toxin can help.