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PD EDS – DA Review First — SCE Neurology MCQ

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EasyMovement DisordersPD EDS – DA Review FirstSCE Neurology

A 60-year-old man with PD develops daytime sleepiness. His ESS is 12/24. He is on co-careldopa and pramipexole. His neurologist wants to address the sleepiness. What is the most important first step?

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Correct answer: D — Review dopaminergic medication — dopamine agonists (pramipexole) are the most common pharmacological cause of excessive daytime sleepiness and sudden-onset sleep in PD; consider dose reduction or switch to an alternative

Dopamine agonists (pramipexole, ropinirole) are the most common cause of excessive daytime sleepiness (EDS) in PD, including sudden-onset sleep episodes. NICE NG71 recommends reviewing and adjusting dopaminergic medication before starting any wake-promoting agents. If the DA is responsible, options include: dose reduction, switching to an alternative DA, or replacing the DA with levodopa or a MAO-B/COMT inhibitor. If sleepiness persists after medication optimisation, investigate for other sleep disorders (OSA, sleep fragmentation) and consider modafinil. A: Medication review should precede adding drugs. C: Methylphenidate is not first-line. D: Sleepiness is often modifiable. E: Increasing pramipexole would worsen sleepiness.

Reference: NICE NG71; BNF