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There is an outstandingly informative article on the management of Parkinson Disease available in full text at http://www.medscape.com. It's title: "Practical Guidelines for Management of Parkinson Disease". The author is Bayla v. Manyam, MD of the Parkinson's Disease Movement Disorders Clinic, Department of Neurology, Southern Illinois University School of Medicine. It was published in J Am Board Fam Pract 10(6):412-424, 1997. (A search for full text documents using Parkinson will provide a number of informative articles, including this one.) Abstract Background: This article describes a specialist's perspective on the challenge of caring for patients with Parkinson disease in a changing American health care environment that places increasing responsibility on primary care physicians. Methods: Guidelines were developed by drawing from a combination of personal experience at a large university Parkinson disease clinic, literature review, presentations at various family practice continuing medical education conferences, and involvement as investigator in various clinical trials of drugs used in Parkinson disease treatment. Results and Conclusions: From a therapeutic standpoint, Parkinson disease can be divided into three stages—early, nonfluctuating, and fluctuating. Although the same drugs, namely, carbidopa-levodopa preparations, dopamine agonists, and anticholinergic medications, are usually prescribed, their pattern of use, including frequency and dosing, varies depending on the nature of the dominant symptoms and stage of the disease. Management of Parkinson disease requires familiarity with both the disease- related and drug-related components. Optimal functional efficiency for the patient is gained through striking a delicate balance between the drug regimen and the disease-related components. (J Am Board Fam Pract 10(6):412-424, 1997. © 1997 American Board of Family Practice] There have been so many doctor-patient communication problems reported here that we really appreciated the following approach to dealing with patients that was recommended by the author: "Unlike treatment for many diseases, treatment of Parkinson disease is tailor-made for each patient. The plan should be to redefine the therapeutic goal at various stages of the disease. This plan should be discussed with the patient to promote realistic expectations. The primary goal in all stages is to attain functional improvement in the patient's condition by using the fewest drugs as infrequently as possible." Recommendations for medication and other treatments at each stage of PD are detailed here. The article also includes a complete list of diseases or conditions with Parkinson-like symptoms. Martha Rohrer (CG for Neal, 77/12) [log in to unmask]