Ataxia / dystonia / tremor

• Ataxia (NHS Choices), Dystonia (NHS Choices), Essential tremor (NHS Choices)

Parkinsonism

• Umbrella term for the clinical syndrome involving bradykinesia (slowness of movement) plus ≥ 1 of tremor, rigidity, postural instability

• Causes: Parkinson's disease (most common), drug-induced, cerebrovascular disease, Lewy body dementia, multiple system atrophy, and progressive supranuclear palsy

Parkinson's disease

• Chronic, progressive neurodegenerative condition resulting from the loss of the dopamine-containing cells of the substantia nigra. PD not clinically apparent until at least 50% of dopaminergic cell activity has been lost. Most cases are considered to arise sporadically, although up to 20% of people with PD have a FH in a first-degree relative: Parkinson's disease (CKS), Parkinson's disease (NHS Choices), Parkinson's UK, Parkinson's disease (Mayo clinic)

• Entacapone prevents the peripheral breakdown of levodopa, by inhibiting catechol-O-methyltransferase, allowing more levodopa to reach the brain - can only be prescribed under specialist supervision under a shared care agreement with the GP.

Drugs to avoid include:

• Metoclopramide (dopamine antagonist)

• Prochlorperazine

• Perphenazine

• Flupentixol

• Chlorpromazine

• Fluphenazine

• Haloperidol

• Pimozide

• Sulpiride

• Trifluoperazin

Serotonin syndrome

• Serotonin syndrome: Serotonin syndrome (BMJ, 2014)

Tourette syndrome