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Cauda Equina – Surgical Emergency — SCE Neurology MCQ

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HardNeurorehabilitationCauda Equina – Surgical EmergencySCE Neurology

A person with advanced Parkinson’s disease has unpredictable off periods and dyskinesia despite optimised oral therapy. Cognition is preserved and there are no troublesome hallucinations. What is the next step?

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Correct answer: A — Refer to a specialist advanced-therapy service to assess apomorphine

The best answer is “Refer to a specialist advanced-therapy service to assess apomorphine”. Refractory motor fluctuations warrant multidisciplinary assessment for device-aided therapy; suitability differs by cognition, comorbidity and symptom profile. “Add progressively larger unsupervised rescue levodopa doses” can be reasonable in another presentation, but it does not account for the defining feature here. “Stop all dopaminergic treatment abruptly” can be reasonable in another presentation, but it does not account for the defining feature here. “Offer deep-brain stimulation without multidisciplinary selection” can be reasonable in another presentation, but it does not account for the defining feature here. “Use antipsychotic treatment solely to reduce dyskinesia” can be reasonable in another presentation, but it does not account for the defining feature here.

Reference: NICE NG71 Parkinson’s disease recommendations: https://www.nice.org.uk/guidance/ng71/chapter/recommendations