skip to main content

PD – Random On-Off — SCE Neurology MCQ

Instant feedback + full explanation. One question, done properly.

HardMovement DisordersPD – Random On-OffSCE Neurology

A 64-year-old with advanced Parkinson disease has recurrent prolonged OFF periods despite optimised oral and transdermal treatment. Cognition is preserved, and he declines both intracranial surgery and an enteral tube. Which advanced treatment best matches his symptom pattern and preferences?

Educational content. Not a substitute for clinical judgement or local policy.

Reveal the answer and explanation

Correct answer: A — Use continuous subcutaneous apomorphine infusion after specialist assessment and response testing

NICE includes continuous subcutaneous apomorphine infusion within best medical therapy for advanced Parkinson disease when optimised oral or transdermal regimens do not control recurrent prolonged OFF periods. Specialist initiation and response assessment are required. Intermittent injections can rescue discrete OFF episodes but do not provide the continuous waking-day coverage sought here. Further oral or patch escalation has already failed, while intestinal gel requires the enteral access that the patient declines.

Reference: NICE NG71: https://www.nice.org.uk/guidance/ng71/chapter/Recommendations