Parkinson Society Canada, in partnership with leading Canadian movement disorder specialists, has launched the first clinical guidelines for the diagnosis and treatment of Parkinson’s disease.
The Canadian Guidelines on Parkinson’s Disease will be published in the July 2012 issue of the Canadian Journal of Neurological Sciences and will include an executive summary and quick reference guide in English and French. They will be distributed to family physicians, pharmacists, nurses and allied health professionals including occupational therapists, physiotherapists and speech-language pathologists.
Before now, there has been no consistent standard by which Parkinson’s has been diagnosed or treated in Canada. The new guidelines are designed to provide health care professionals with practical clinical advice for the diagnosis and treatment of Parkinson’s, based on either the best published evidence or on expert consensus when there is a lack of evidence.
“Most Canadians with Parkinson’s do not attend specialized Parkinson’s or movement disorders clinics,” says Dr. David Grimes, Director of the Ottawa Hospital’s Parkinson’s Disease and Movement Disorders Clinic and editor of the guidelines. “A tool was needed so that all health care providers who treat people with Parkinson’s in Canada have a clear idea on how best to help individuals manage their disease. The guidelines are meant to improve the standard of care and access to care for people with Parkinson’s in all regions of Canada.”
The guidelines are the culmination of four years of development, sparked by a two-day meeting in January 2008, when 50 of Canada’s leading researchers and clinicians met with Parkinson Society Canada, to share ways to collaborate, promote and advocate for excellence in Parkinson’s clinical care and research.
The guidelines were written collaboratively by neurologists and movement disorder specialists from across Canada, with input from people with Parkinson’s, surgeons, family physicians, nurses, allied health professionals and Parkinson Society Canada. The 84 recommendations are designed primarily for family physicians, neurologists and other health care professionals, however they may also be helpful for policy decision-makers and funding bodies.
People with Parkinson’s are encouraged to let their health care providers know that the Canadian Guidelines on Parkinson’s Disease are available online at www.parkinsonclinicalguidelines.ca. The website and other materials relating to the guidelines have been made possible through unrestricted educational grants from Abbott Laboratories, Limited, Merck Canada Inc., Novartis Pharmaceuticals Canada Inc., Teva Canada Innovation and UCB Canada Inc.
The guidelines are endorsed by the Canadian Neurological Sciences Federation and Parkinson Society Canada.
The guidelines call for a person-centred approach to care and treatment, with open and honest communication between the health care professional and the person with Parkinson’s. The recommendations state that people with Parkinson’s should have the opportunity to make informed decisions based on full disclosure of all relevant information and that care decisions should be based upon best available evidence and provided according to applicable professional standards. They also suggest that families and caregivers be given information not only about Parkinson’s but also about entitlements to care assessment and available support services.
Diagnosis and progression
The guidelines highlight the need for clinicians to differentiate Parkinson’s from other forms of parkinsonism and to distinguish it from other causes of tremor, such as drugs, neurotoxins and structural brain lesions. They recommend prompt referral to a specialist with expertise in the differential diagnosis of Parkinson’s and outline the complexity of Parkinson’s and the substantial variation of symptoms from person to person.
The guidelines acknowledge that there is a wide range of treatments for Parkinson’s symptoms, including medications, surgical procedures, physiotherapy, occupational therapy and other support services. The guidelines suggest that these treatments can have a significant impact on improving quality of life and should be available.
An entire section is devoted to non-motor features of Parkinson’s, such as mental health problems – depression, psychotic symptoms, dementia; sleep disorders; autonomic dysfunction – urinary dysfunction, weight loss, constipation, erectile dysfunction, among other examples. The guidelines recommend that people receive appropriate treatment for these symptoms that can contribute to increased disability and have a negative impact on quality of life.