Updated NICE guideline published

The NICE NG71 guideline for the assessment and management of Parkinson's in people aged 18 and over has been published.

It updates and replaces the NICE CG35 guideline which was published in June 2006.

It offers recommendations on all aspects of care from diagnosis and pharmacological management of both motor and non-motor symptoms through to palliative care.

More guidance

Specifically, this update includes more comprehensive guidance on:

• methods to diagnose Parkinson's
• initial treatment of symptoms (taking into account the person's lifestyle and needs and with full discussion of benefits and risks of each treatment option)
• integration of physiotherapy and physical activity, occupational therapy, speech and language therapy and nutrition into the early stages of management
• management and monitoring of impulsive and compulsive behaviours
• medical management of non-motor symptoms
• managing hallucinations and delusions associated with Parkinson's
• medical treatment of Parkinson's dementia
• medications to treat drooling
• medications that can be used as neuroprotective therapies

However the guidance around the management of depression has not been reviewed. Instead, it's recommended that practitioners use the NICE guideline CG91 on depression in adults with a chronic physical health problem.

There are some really positive elements such as the acknowledgement of how important it is for people with Parkinson's to access therapy input from the start.

Excellence Network Clinical Director Professor David Burn

In addition, the recommendation for using duodopa is unclear with the statement: "10.3.7 - 90. Levodopa–carbidopa intestinal gel is currently available through an NHS England clinical commissioning policy. It is recommended that this policy is reviewed in light of this guideline."

Positive elements

Commenting on the guideline, Excellence Network Clinical Director Professor David Burn said:

"It is good to see this long-awaited update to the NICE guidelines published.

"There are some really positive elements such as the acknowledgement of how important it is for people with Parkinson's to access therapy input from the start and a focus on ensuring conversations about medications fully outline potential risks such as impulsive and compulsive behaviour. 

"However the recommendation around duodopa will not give confidence to those who rely on this treatment. And the specific needs of people with Parkinson's who have depression do not seem to have been recognised.

"On this last point, I would urge professionals to get involved in the All-Party Parliamentary Group inquiry on depression and anxiety in Parkinson's so that we can ensure people get the mental health support they need."