مرض باركنسون

• A neurologist's letter recording when symptoms began, which side was affected first, and the current motor and non-motor symptoms.
• A complete list of your medicines with doses and timings, and a diary of when they work well and when they wear off.
• Brain MRI report, usually requested to exclude other causes such as strokes or other parkinsonian conditions.
• Response to levodopa, ideally recorded as a formal before-and-after assessment, since this strongly shapes surgical suitability.
• Any cognitive or memory testing and notes on mood, sleep, falls, swallowing or low blood pressure on standing.

1. How confident are you that this is Parkinson's disease rather than a related condition, and what would change that view?
2. Are my medicines optimised, and what other drug options remain before surgery is considered?
3. What are my off periods and dyskinesias like, and do they meet the criteria for deep brain stimulation?
4. Which symptoms can stimulation help, and which, such as balance or speech, may not improve?
5. What non-drug help, such as physiotherapy, speech therapy and exercise, should I be doing now?
6. How often will I need review, and what changes should prompt an earlier visit?

Parkinson's disease is not curable, but symptoms can be controlled well for many years. Progression is gradual and varies widely between people. Tremor and stiffness usually respond to levodopa, while balance, speech, swallowing and memory changes tend to respond less. Life expectancy is close to normal for many people, especially with good care. Outlook depends on age at onset, the dominant symptoms, the presence of cognitive change and how well medicines are tolerated over time.