Multidisciplinary care for Parkinson’s disease: not if, but how!

Increasingly, many centres around the world are delivering multidisciplinary care for patients with Parkinson’s disease (PD).1 2 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.3 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.4–6 Moreover, conventional therapies—drug treatment and stereotactic deep brain surgery—offer only partial and temporary relief, particularly in more advanced disease.7 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.8