When to refer

If the diagnosis is unclear at the time of initial presentation, it is appropriate either to review the patient at a later date or to refer the patient for more neurological assessment.

Once diagnosed or highly suspected it is best to refer to establish the diagnosis and to seek advice on initiation of treatment. Patients and families usually prefer this approach. In the initial years before motor fluctuations develop, management could be performed by the general practitioner according to an overall plan developed in liaison with a neurological colleague. When fluctuations develop and endstage diseases manifest (e.g. gait disorders) specialist supervision is appropriate. 1

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