Medications and their monitoring in Parkinson's disease in Dunedin

to establish the patterns of drug administration and monitoring in people with Parkinson's disease.

a total community sample was obtained. One hundred and one of the 116 people with Parkinson's disease in Dunedin, who were alive on 31 July 1990, had a full medical assessment.

the general practitioner made the diagnosis in 51%, a neurologist in 22%, a geriatrician in 18%, and other in 9%. The general practitioner provided prescriptions for 51 of the 68 people living in the community, a neurologist for 11, and a geriatrician in six cases. The general practitioner provided prescriptions for 23 of the 33 living in an institution, and a geriatrician in ten cases. Medical review took place more frequently than three monthly in 49 cases. There were 81 general practitioners in practice on the prevalence day in the study area. Thirty-six had no patients with Parkinson's disease, 30 had one or two, and the other 15 had varying numbers. Fifty-eight of the 90 patients taking levodopa were taking it as the only therapy. Eight patients were taking phenothiazines. There was a high incidence of side effects and 70 patients had long term complications including loss of effectiveness over time, the end of dose and the on-off phenomena, and dyskinesias.

monitoring of treatment appeared satisfactory but major concerns about drug management included the high use of levodopa monotherapy and the concurrent use by general practitioners of phenothiazines in eight cases. Because most general practitioners have very few patients with Parkinson's disease they will not develop the experience to manage complicated drug regimens in people whose management tends to become more difficult with time. With selegiline and controlled release levodopa only being available on specialist prescription, we suggest that all people with Parkinson's disease should have the benefit of a specialist review at least every two years.