April 2011
Post B, van der Eijk M, Munneke M, Bloem BR
Increasingly, many centres around the world are delivering multidisciplinary care for patients with Parkinson's disease (PD).
Indeed, a multidisciplinary team approach currently seems inevitable
for anyone who understands even a little about PD. After
all, this really is a wretched disorder,
with a complex and diverse phenotype.
Patients become progressively
incapacitated,
not only because of the well known motor
symptoms (bradykinesia, rigidity, tremor, gait impairment and postural
instability),
but also because of a wide variety of
non-motor symptoms. These include neuropsychiatric disorders (cognitive
disturbances,
hallucinations, psychosis), sleep
disorders (insomnia, rapid eye movement sleep behaviour disorder,
periodic leg movements),
autonomic dysfunction (orthostatic
hypotension, constipation, urinary incontinence, erectile dysfunction)
and pain from various
sources (eg, central pain, painful off
period dystonia). Not surprisingly, PD is regarded by patients as one of
the most unbearable
disorders around, ranked second on the
respective lists for both motor and cognitive disorders.Perhaps even more telling is the fact that many immediate caregivers are on the brink of succumbing to the pressure of living
with someone with PD.Moreover, conventional therapies—drug treatment and stereotactic deep
brain surgery—offer only partial and temporary relief, particularly in
more advanced disease.
Against this
background, any neurologist who still feels that a single discipline
suffices to combat this debilitating disease must seem almost heartless,
or at least a bit naive. And any potential critics should be consoled
by the fact that multidisciplinary care has already won its spurs in
other areas of neurology—for example, stroke units.
