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PD – Rotigotine Patch for Nocturnal Symptoms — SCE Neurology MCQ

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ModerateMovement DisordersPD – Rotigotine Patch for Nocturnal SymptomsSCE Neurology

A 68-year-old man with Parkinson's disease has troublesome nocturnal symptoms including difficulty turning in bed, early morning off-state stiffness, nocturia, and vivid dreams. His daytime motor control is acceptable on co-careldopa 25/100 TDS. What medication adjustment may improve his nocturnal symptoms?

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Correct answer: C — Add rotigotine transdermal patch — it provides continuous dopaminergic stimulation overnight

Rotigotine is a transdermal dopamine agonist patch that provides continuous 24-hour dopaminergic stimulation. It is particularly useful for nocturnal symptoms in PD (nocturnal akinesia, early morning off-state, restless legs, difficulty turning in bed) because the patch maintains steady drug levels overnight. NICE NG71 recommends considering rotigotine for nocturnal akinesia if levodopa and/or oral dopamine agonists are ineffective. A: Stopping medications would worsen nocturnal symptoms. C: Morning dose adjustment doesn't address overnight issues. D: Anticholinergics cause cognitive side effects in the elderly. E: All doses at bedtime would cause overnight peak and daytime troughs.

Reference: NICE NG71 Parkinson's Disease (2017); BNF – Rotigotine