When should I consider referring a patient with movement disorders to a neurologist for further evaluation?

Consider referring a patient with movement disorders to a neurologist for further evaluation in the following situations:

• Adults with difficulty in handwriting that is small and slow, suggestive of possible Parkinson's disease.
• Adults with difficulty specific to handwriting without other abnormalities, for possible focal dystonia.
• Adults with involuntary movements of the face, neck, limbs, or trunk that cannot be temporarily suppressed by mental concentration.
• Adults with suspected parkinsonian tremor, asymmetric tremor, or tremor associated with stiffness, slowness, balance problems, or gait disorders.
• Adults with troublesome tremor of the head, especially if first-line treatments are ineffective or not tolerated.
• Adults with suspected dystonia, including persistent abnormalities of head or neck posture or other body parts.
• Adults with tics that are troublesome, accompanied by progressive neurological symptoms, or severe and distressing despite psychological therapy.
• Children with sudden-onset chorea, ataxia, dystonia, or tremor with additional neurological signs or sudden onset.

Do not routinely refer adults with simple tics or isolated small muscular twitches unless associated with other neurological signs such as muscle wasting or weakness.

Referral should be urgent if symptoms are rapidly progressive or associated with other neurological deficits.

These recommendations align with the NICE guideline on suspected neurological conditions: recognition and referral.

References: NICE NG127