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Movement disorders including Parkinson’s disease and dystonia

Movement disorders including Parkinson’s disease and dystonia

Emergency and immediate referrals

Referral to Emergency Department

If any of the following are present or suspected, please refer the patient to the emergency department (via ambulance if necessary) or seek emergency medical advice if in a remote region:

  • Sudden movement disorder involving ocular movement

Immediately contact on-call registrar or service to arrange an immediate neurology assessment (seen within 7 days) for:

  • Severe symptoms or abrupt onset/deterioration of movement disorder

To contact the relevant service, please see HealthPathways: Acute Neurology Assessment

Presenting issues
  • Patient aged <65 and at least one of:
    • New or progressive tremor, non-essential tremor
    • Suspected Parkinson’s disease or movement disorder
    • Motor or non-motor complications of Parkinson’s disease leading to substantial disability
  • Dystonia, chorea, myoclonus
Mandatory referral information (referral will be returned if this information is not included)

History

  • Relevant history, onset and duration of symptoms including:
    • Evolution of symptoms - progressive, stable or improving
    • Evidence of tremor
    • Information on patient's gait
  • Degree of functional impairment (e.g. impact on mobility/falls/employment/ADLs/weight loss/carer information)

Investigations

  • TSH for tremors

If unable to attach reports, please include relevant information/findings in the body of the referral

Referrer to state reason if not able to include mandatory information in referral (e.g. patient unable to access test due to geographical location or financial cost)
Highly desirable referral information
  • Detailed history of abnormal movements
  • Accurate neurological exam results
  • U&Es
  • LFTs
  • Any investigations done to exclude alternative diagnoses e.g. nerve conduction study, EEG, CT Brain and MRI Brain
  • Indicate whether the patient has previously attended neurology clinic or seen a neurologist
    • If so please attach contact details, dates and any other information and correspondence relating to these visits
Indicative triage category
Indicative triage category
Category 1
Appointment within 30 days
  • No defined category 1 criteria
Category 2
Appointment within 90 days		 Known or suspected:
  • Parkinson's Disease (<65 years)
  • Dystonia
  • Myoclonus
  • Huntington’s disease
  • Tardive dyskinesia 
Category 3
Appointment within 365 days
  • Non-progressive movement disorder i.e. essential tremor
Excluded neurology services

Referral to public adult neurology outpatient services is not routinely accepted for the following conditions:

Condition Details (where applicable)
Parkinson’s disease > 65 years old unless referred by specialist
Last reviewed: 29-06-2023
wa.gov.au