HHE Neurology supplement 2018 - Page 4

neurology 2018 NICE Guidelines for Parkinson’s disease Clinicians will be trying to adhere to the updated NICE guidelines, but what are the implications for commissioners and providers of services for people with Parkinson’s disease? Richard Grünewald MA DPhil FRCP Consultant Neurologist and Clinical Director of Neurosciences, Sheffield Teaching Hospitals NHS Foundation Trust; Department of Neurology, Royal Hallamshire Hospital, UK In July 2017, The National Institute of Health and Care Excellence (NICE) published revised guidelines for Parkinson’s disease in adults. 1 Clinicians will be trying to adhere to these, but what are the implications of these guidelines for commissioners and providers of services for people with Parkinson’s disease? Parkinson’s disease is a progressive degenerative disorder, and one of the more common neurological conditions, with an annual incidence in the UK of 15–20 per 100,000 and a prevalence of 1 in 625 of the adult population. 2 Patients with the condition become progressively disabled by a combination of movement problems (mainly slowness and difficulty initiating movement), and non-motor symptoms such as mental disturbances, autonomic disturbance 4 HHE 2018 | hospitalhealthcare.com (for example, involving sweating, salivation, swallowing and digestion, sexual function, micturition and blood pressure control), cognitive failure and pain. Ultimately the condition becomes dominated by symptoms that respond poorly to medical management, and palliative care is required. Management of Parkinson’s disease is therefore complex and can be resource intensive. Secondary care services are usually involved early, either Neurology or Care of the Elderly, depending on age, co-morbidity of the patient and local provision. Without effective care systems, the burden of care on family and carers can be intolerable, and the use of emergency care disproportionate. Patients and their carers need effective means of communication with the