16/08/2026
Medicine Class 29
Parkinsonâs Disease (PD) / Dementia / Restless Legs Syndrome (RLS)
ā§§. āĻā§āϞāĻŋāύāĻŋāĻā§āϝāĻžāϞ āϏāĻŋāύāĻžāϰāĻŋāĻ (Clinical Scenario)
āĻāĻĒāύāĻžāϰ āĻā§āĻŽā§āĻŦāĻžāϰ⧠āĻāĻ āĻāĻ āĻĒā§āϰāĻŦā§āĻŖ āĻāϞā§āύ āϝāĻžāϰ āĻšāĻžāϤ āĻāĻžāĻāĻĒāĻā§, āĻšāĻžāĻāĻāĻžāϰ āĻāϤāĻŋ āĻ
āϤā§āϝāύā§āϤ āϧā§āϰ āĻāĻŦāĻ āĻŽā§āĻā§āϰ āĻ
āĻāĻŋāĻŦā§āϝāĻā§āϤāĻŋ āϏā§āĻĨāĻŋāϰ āĻšā§ā§ āĻāĻā§ (Masked face)âāĻāĻāĻŋ āĻĒāĻžāϰāĻāĻŋāύāϏāύā§āϏ āĻĄāĻŋāĻāĻŋāĻāĨ¤ āϤāĻžāĻāϰāĻ āϏāĻžāĻĨā§ āĻāϏāĻž āϏāĻā§āĻā§āĻāĻŋ āĻŦāĻžāϰāĻŦāĻžāϰ āĻāĻāĻ āĻāĻĨāĻž āĻāĻŋāĻā§āĻā§āϏ āĻāϰāĻā§āύ, āϤāĻŋāύāĻŋ āĻšā§āϤ⧠āĻāϤ āϏāĻĒā§āϤāĻžāĻšā§āϰ āĻāĻĨāĻž āĻŽāύ⧠āĻāϰāϤ⧠āĻĒāĻžāϰāĻā§āύ āύāĻž, āϏāĻŽā§ā§āϰ āϏāĻžāĻĨā§ āϏāĻžāĻĨā§ āϤāĻžāĻāϰ āϏā§āĻŽā§āϤāĻŋāĻļāĻā§āϤāĻŋ āĻŦāĻŋāϞā§āύ āĻšā§ā§ āϝāĻžāĻā§āĻā§âāĻāĻāĻŋ āĻĄāĻŋāĻŽā§āύāĻļāĻŋāϝāĻŧāĻžāĨ¤ āĻāϰ āĻĻāĻŋāύ āĻļā§āώ⧠āĻāĻ āϰā§āĻā§ āĻ
āĻāĻŋāϝā§āĻ āĻāϰāϞā§āύ, āϏāύā§āϧā§āϝāĻžā§ āĻļā§āϤ⧠āĻā§āϞ⧠āϤāĻžāĻāϰ āĻĒāĻžā§ā§āϰ āĻā§āϤāϰ⧠āĻ
āĻĻā§āĻā§āϤ āĻ
āϏā§āĻĨāĻŋāϰāϤāĻž āĻļā§āϰ⧠āĻšā§, āϝā§āύ āĻāĻŋāĻā§ āĻāĻāĻāĻž āĻšā§āĻāĻā§ āĻŦā§ā§āĻžāĻā§āĻā§, āĻāϰ āĻšāĻžāĻāĻāĻžāĻāϞāĻž āĻāϰāϞā§āĻ āĻā§āĻŦāϞ āĻāϰāĻžāĻŽ āϞāĻžāĻā§âāĻāĻāĻŋ āϰā§āϏā§āĻāϞā§āϏ āϞā§āĻ āϏāĻŋāύāĻĄā§āϰā§āĻŽ (RLS)āĨ¤ āĻāĻ āĻĒā§āϰāϤāĻŋāĻāĻŋ āϏāĻŽāϏā§āϝāĻžāĻ āĻāĻāĻāύ āĻŦā§āϏā§āĻ āĻŽāĻžāύā§āώā§āϰ āϏā§āĻŦāĻžāĻāĻžāĻŦāĻŋāĻ āĻā§āĻŦāύāϝāĻžāϤā§āϰāĻžāĻā§ āĻĻā§āϰā§āĻŦāĻŋāώāĻš āĻāϰ⧠āϤā§āϞā§āĨ¤
⧍. āĻāĻāĻŋāĻĄā§āύā§āϏ āĻŦā§āĻāĻāĻĄ āĻāĻžāĻāĻĄāϞāĻžāĻāύ (Guidelines)
āĻĒāĻžāϰāĻāĻŋāύāϏāύā§āϏ: āĻāϰ āĻŽā§āϞ āĻāĻžāϰāĻŖ āĻŽāϏā§āϤāĻŋāώā§āĻā§āϰ āĻĄā§āĻĒāĻžāĻŽāĻŋāύ āύāĻŋāĻāϏāϰāĻŖāĻāĻžāϰ⧠āύāĻŋāĻāϰāύā§āϰ āĻā§āώā§āĨ¤ āĻĒā§āϰāĻĨāĻžāĻāϤ āĻāĻŋāĻāĻŋā§āϏāĻžā§ āϞā§āĻā§āĻĄā§āĻĒāĻž (Levopa) āĻāĻŦāĻ āĻ
ā§āϝāĻžāύā§āĻāĻŋ-āĻā§āϞāĻŋāύāĻžāϰā§āĻāĻŋāĻ āĻĄā§āϰāĻžāĻ (Hexinor) āĻāϰ āĻŽāĻžāϧā§āϝāĻŽā§ āĻĄā§āĻĒāĻžāĻŽāĻŋāύā§āϰ āĻāĻžāϰāϏāĻžāĻŽā§āϝ āϰāĻā§āώāĻž āĻāϰāĻž āĻšā§āĨ¤
āĻĄāĻŋāĻŽā§āύāĻļāĻŋāϝāĻŧāĻž: āĻāĻāĻŋ āĻā§āĻŦāϞ āĻŦā§āϏā§āϰ āϏā§āĻŦāĻžāĻāĻžāĻŦāĻŋāĻ āĻĒāϰāĻŋāĻŦāϰā§āϤāύ āύā§, āĻāϰ āĻĒā§āĻāύ⧠āĻ
ā§āϝāĻžāϞāĻāĻžāĻāĻŽāĻžāϰā§āϏ āĻĄāĻŋāĻāĻŋāĻ āĻĨā§āĻā§ āĻļā§āϰ⧠āĻāϰ⧠āĻāĻŋāĻāĻžāĻŽāĻŋāύ āĻŦāĻŋ⧧⧍-āĻāϰ āĻ
āĻāĻžāĻŦ āĻŦāĻž āϏāĻžāĻŦāĻĄā§āϰāĻžāϞ āĻšā§āĻŽāĻžāĻā§āĻŽāĻžāϰ āĻŽāϤ⧠āϰāĻŋāĻāĻžāϰā§āϏāĻŋāĻŦāϞ āĻāĻžāϰāĻŖ āĻĨāĻžāĻāϤ⧠āĻĒāĻžāϰā§āĨ¤ āϤāĻžāĻ āĻāĻžāĻāĻĄāϞāĻžāĻāύ āĻ
āύā§āϝāĻžā§ā§, āĻĒā§āϰā§āĻŖāĻžāĻā§āĻ āĻāύāĻā§āϏā§āĻāĻŋāĻā§āĻļāύ āĻāϰ⧠āĻāĻžāϰāĻŖ āĻāĻŋāĻšā§āύāĻŋāϤ āĻāϰāĻž āĻ
āϤā§āϝāĻžāĻŦāĻļā§āϝāĻāĨ¤
āĻāϰāĻāϞāĻāϏ (RLS): āĻāĻžāĻāĻĄāϞāĻžāĻāύ āĻ
āύā§āϝāĻžā§ā§, āĻāĻāĻŋ āĻ
āύā§āĻ āϏāĻŽā§ āĻā§āϰāύ āĻŦāĻž āĻāĻŋāĻāĻžāĻŽāĻŋāύ āĻŦāĻŋ⧧⧍-āĻāϰ āĻ
āĻāĻžāĻŦāĻāύāĻŋāϤ āĻāĻžāϰāĻŖā§ āĻšā§āĨ¤ āϤāĻžāĻ āĻāĻŋāĻāĻŋā§āϏāĻžāϰ āĻāĻā§ CBC āĻ āĻŽā§āĻāĻžāĻŦāϞāĻŋāĻ āϏā§āĻā§āϝāĻžāĻāĻžāϏ āĻĒāϰā§āĻā§āώāĻž āĻāϰāĻž āĻā§āĻŦāĻ āĻā§āϰā§āϤā§āĻŦāĻĒā§āϰā§āĻŖāĨ¤
ā§Š. āĻĒā§āϰā§āϝāĻžāĻāĻāĻŋāĻā§āϝāĻžāϞ āĻŽā§āϝāĻžāύā§āĻāĻŽā§āύā§āĻ (Practical Management)
āĻĒāĻžāϰāĻāĻŋāύāϏāύā§āϏ: Tab. Levopa (Levodopa) āϰāĻŋāĻāĻŋāĻĄāĻŋāĻāĻŋ āĻ āĻŦā§āϰā§āϝāĻžāĻĄāĻŋāĻāĻžāĻāύā§āĻļāĻŋāϝāĻŧāĻžāϰ āĻĒā§āϰāϧāĻžāύ āĻāώā§āϧāĨ¤ āĻāĻžāĻāĻĒā§āύāĻŋ āĻāĻŽāĻžāϤ⧠Hexinor āϝā§āĻ āĻāϰāĻž āĻšā§āĨ¤ āϝāĻĻāĻŋ āϰā§āĻā§ āĻŦāĻŋāĻā§āϰāĻŽ āĻŦāĻž āĻšā§āϝāĻžāϞā§āϏāĻŋāύā§āĻļāύ⧠āĻā§āĻā§āύ, āϤāĻŦā§ Tab. Quiet (Quetiapine) āĻŦā§āϝāĻŦāĻšāĻžāϰ āĻāϰāĻž āĻšā§āĨ¤
āĻĄāĻŋāĻŽā§āύāĻļāĻŋāϝāĻŧāĻž: āϏā§āĻŽā§āϤāĻŋāĻļāĻā§āϤāĻŋāϰ āĻāύā§āύāϤāĻŋāϰ āĻāύā§āϝ Cap. Rivacap (Rivastigmine) āĻšāϞ⧠āĻŽā§āϞ āĻāώāϧāĨ¤ āϰā§āĻā§āϰ āĻ
āϏā§āĻĨāĻŋāϰāϤāĻž (Agitation) āĻāĻŽāĻžāϤ⧠Tab. Esita (Escitalopram) āĻŦāĻž Tab. Rivotril āĻŦā§āϝāĻŦāĻšāĻžāϰ āĻāϰāĻž āĻšā§, āϤāĻŦā§ āĻāĻā§āϞ⧠āϏāϤāϰā§āĻāϤāĻžāϰ āϏāĻžāĻĨā§ āĻĻāĻŋāϤ⧠āĻšā§āĨ¤
āĻāϰāĻāϞāĻāϏ: Tab. Lyric (Pregabalin) āĻāĻŦāĻ Rivotril (Clonazepam) āϰāĻžāϤā§āϰ āĻ
āϏā§āĻĨāĻŋāϰāϤāĻž āĻāĻŽāĻžāϤ⧠āĻĻāĻžāϰā§āĻŖ āĻāĻžāϰā§āϝāĻāϰāĨ¤ āĻā§āϰāύā§āϰ āĻ
āĻāĻžāĻŦ āĻĨāĻžāĻāϞ⧠Cap. Prenat XL-āĻāϰ āĻŽāϤ⧠āĻā§āϰāύ āϏāĻžāĻĒā§āϞāĻŋāĻŽā§āύā§āĻ āĻĻā§āĻā§āĻž āĻšā§āĨ¤ āϝāĻĻāĻŋ āϤāĻžāϤā§āĻ āĻāύā§āύāϤāĻŋ āύāĻž āĻšā§, āϤāĻŦā§ āĻĒāĻžāϰā§āĻāĻŋāύāϏāύā§āϰ āĻāώā§āϧ 'Parixol' (Pramipexole) āĻŦā§āϝāĻŦāĻšāĻžāϰā§āϰ āĻĒāϰāĻžāĻŽāϰā§āĻļ āĻĻā§āĻā§āĻž āĻšā§āĨ¤
ā§Ē. āϏāϤāϰā§āĻāϤāĻž āĻ āĻāĻŋāĻĒāϏ (Tips & Warnings)
āϏāĻŦāĻā§āϝāĻŧā§ āĻŦāĻĄāĻŧ āĻā§āϞ: āĻĄāĻŋāĻŽā§āύāĻļāĻŋāϝāĻŧāĻžāϰ āϰā§āĻā§āĻā§ āĻā§āĻŦāϞ āĻā§āĻŽā§āϰ āĻāώā§āϧ āĻāĻžāĻā§ā§ āĻā§āϞāĻŋā§ā§ āϰāĻžāĻāĻžāĨ¤ āĻŽāύ⧠āϰāĻžāĻāĻŦā§āύ, āĻŦāĻžāϰāĻŦāĻžāϰ āĻāĻŋāĻā§āĻā§āϏ āĻāϰāĻž āĻŦāĻž āϏā§āĻŽā§āϤāĻŋāĻā§āϰāώā§āĻāϤāĻžāϰ āĻĒā§āĻāύ⧠āĻā§āύ⧠āĻļāĻžāϰā§āϰāĻŋāĻ āĻāĻžāϰāĻŖ (āϝā§āĻŽāύâāĻĨāĻžāĻāϰā§ā§āĻĄ āϏāĻŽāϏā§āϝāĻž āĻŦāĻž āĻāĻŋāĻāĻžāĻŽāĻŋāύ āĻŦāĻŋ⧧⧍-āĻāϰ āĻ
āĻāĻžāĻŦ) āϞā§āĻāĻŋā§ā§ āĻāĻā§ āĻāĻŋāύāĻž, āϤāĻž āϰā§āϞ-āĻāĻāĻ āĻāϰāĻž āĻāĻĒāύāĻžāϰ āύā§āϤāĻŋāĻ āĻĻāĻžā§āĻŋāϤā§āĻŦāĨ¤
āĻĒāĻžāϰāĻāĻŋāύāϏāύā§āϏ āĻāĻŋāĻĒāϏ: āϞā§āĻā§āĻĄā§āĻĒāĻžāϰ āĻĄā§āĻ āϧā§āϰ⧠āϧā§āϰ⧠āĻŦāĻžā§āĻžāϤ⧠āĻšā§, āĻšā§āĻ āĻāϰ⧠āĻā§āĻŦ āĻŦā§āĻļāĻŋ āĻĄā§āĻ āĻĻā§āĻŦā§āύ āύāĻžāĨ¤ āϰā§āĻā§āϰ āĻāĻžāĻĻā§āϝāĻžāĻā§āϝāĻžāϏ āĻ āύāĻŋā§āĻŽāĻŋāϤ āĻŦā§āϝāĻžā§āĻžāĻŽā§āϰ āĻāĻĒāϰ āĻā§āϰā§āϤā§āĻŦ āĻĻāĻŋāύāĨ¤
āĻāϰāĻāϞāĻāϏ āϏāϤāϰā§āĻāϤāĻž: āϰā§āĻā§āĻā§ āĻŦā§āĻāĻŋā§ā§ āĻŦāϞā§āύ āϝā§, āĻāĻāĻŋ āĻļā§āϧ⧠āĻāĻāĻāĻŋ āĻ
āϏā§āĻŦāϏā§āϤāĻŋ āύā§, āĻāĻāĻŋ āĻļāϰā§āϰā§āϰ āĻā§āύ⧠āĻ
āĻā§āϝāύā§āϤāϰā§āĻŖ āĻāύāĻŋāĻā§āϰ āĻ
āĻāĻžāĻŦā§āϰ āϏāĻāĻā§āϤ āĻšāϤ⧠āĻĒāĻžāϰā§āĨ¤ āĻĒā§āϰāĻā§āϰ āĻĒāĻžāύāĻŋ āĻĒāĻžāύ āĻ āĻĒāϰāĻŋāĻŽāĻŋāϤ āĻšāĻžāĻāĻāĻžāĻāϞāĻžāϰ āĻĒāϰāĻžāĻŽāϰā§āĻļ āĻĻāĻŋāύāĨ¤
āĻĢāϞā§āĻāĻĒ: āĻāĻ āϤāĻŋāύāĻāĻŋ āϰā§āĻāĻ āĻĻā§āϰā§āĻāĻŽā§āϝāĻŧāĻžāĻĻā§āĨ¤ āϤāĻžāĻ āĻĒā§āϰāϤāĻŋ āĻŽāĻžāϏ⧠āĻŦāĻž ⧍ āĻŽāĻžāϏ āĻ
āύā§āϤāϰ āĻāĻāĻŦāĻžāϰ āϰāĻŋ-āĻ
ā§āϝāĻžāϏā§āϏāĻŽā§āύā§āĻ āĻāϰāĻž āĻ
āϤā§āϝāύā§āϤ āĻāϰā§āϰāĻŋāĨ¤ āĻāώāϧā§āϰ āĻĄā§āĻ āϏāĻŽāύā§āĻŦā§ āĻāϰāĻžāϰ āϏāĻŽā§ āϰā§āĻā§āϰ āĻĻā§āύāύā§āĻĻāĻŋāύ āĻāϰā§āĻŽāĻā§āώāĻŽāϤāĻž āĻā§āĻŽāύ āĻĨāĻžāĻāĻā§, āϤāĻž āĻĒāϰā§āϝāĻŦā§āĻā§āώāĻŖ āĻāϰā§āύāĨ¤
Prescription Model:
ā§§. Parkinson Disease (PD)
â C/F:
â Older Age
â Resting Tremor
â Slow Movement (Bradykinesia)
â Rigidity and gait impairment
â O/G/E:
â Appearance: Masked face
â Cogwheel rigidity
â Investigation:
â CT Scan of Brain
â Rx:
â For Rigidity & Bradykinesia:
â Tab. Levopa 110mg, (ÂŊ+ÂŊ+ÂŊ)..... āĻāϞāĻŦā§āĨ¤
(If response increase the dose)
â For Tremor:
â Tab. Hexinor 1mg, (1+0+1)..... āĻāϞāĻŦā§āĨ¤
(If response increase the dose upto 6-10mg/day)
â If Dementia:
â Cap. Rivacap 1.5mg, (1+0+1)..... āĻāϞāĻŦā§āĨ¤
â If Hallucination or Delusion:
â Tab. Quiet 25mg, (0+0+1)..... āĻāϞāĻŦā§āĨ¤
â If not improved in medical treatment:
â Refered to surgery
â āĻāĻĒāĻĻā§āĻļāĻ
â āύāĻŋā§āĻŽāĻŋāϤ āĻāώāϧ āĻāĻžāĻā§āĻžāĻŦā§āύāĨ¤
â āϏā§āĻŦāĻžāϏā§āĻĨā§āϝ āϏāĻŽā§āĻŽāϤ āĻāĻžāĻĻā§āϝ āĻāĻžāĻŦā§āύāĨ¤
â āĻĒāϰāĻŋāĻŽāĻŋāϤ āĻŦā§āϝāĻžā§āĻžāĻŽ āĻāϰā§āύāĨ¤
⧍. Dementia
â C/F:
â Gradually Loss memory
â Common in old age.
â Common Cause:
â Diffuse small-vessel disease
â Alzheimerâs disease
â Secondary deposits
â Chronic subdural haematoma
â Post-head injury
â Alcohol
â O/G/E:
â BP:
â Pulse:
â Anemia:
â Temp:
â Lungs:
â Planter:
â Investigation: (To Findout the Cause)
â CT Scan / MRI of Brain
â CBC
â RBS
â Serum Electrolytes
â FT4, TSH
â S. Calcium
â LFT
â Serum vitamin B12
â VDRL
â Anti-HIV ab (Western blot method)
â ANA, Anti-dsDNA, Anti DNA
â Rx:
â Cap. Rivacap 1.5mg, (1+0+1)..... āĻāϞāĻŦā§āĨ¤
â For Agitation:
â Tab. Esita 5mg, (1+0+0).....ā§§āĻŽāĻžāϏāĨ¤
â Tab. Rivotril 0.5mg, (0+0+1).....ā§§āĻŽāĻžāϏāĨ¤
Or
â Tab. Qutap 25mg, (0+0+1).....ā§§āĻŽāĻžāϏāĨ¤
â āĻāĻĒāĻĻā§āĻļāĻ
â āύāĻŋā§āĻŽāĻŋāϤ āĻāώāϧ āĻāĻžāĻā§āĻžāĻŦā§āύāĨ¤
â āĻā§āύ āϏāĻŽāϏā§āϝāĻž āĻšāϞ⧠āĻĄāĻžāĻā§āϤāĻžāϰā§āϰ āϏāĻžāĻĨā§ āϝā§āĻāĻžāϝā§āĻ āĻāϰāĻŦā§āύāĨ¤
ā§Š. Restless legs syndrome (RLS)
â C/F:
â H/O Uncomfortable sensation in leg
â Relief with movement.
â Worsening at Evening / Night.
â Risk Factor:
â Pregnancy
â Peripheral neuropathy
â Iron deficiency
â Parkinsonism
â Spinal cord lesion
â Kidney failure
â Investigation: (To identify Pathology)
â CBC
â RBS
â S. Creatinine
â Rx:
â Tab. Lyric 25mg, (0+0+1).....ā§āĻĻāĻŋāύ, āϤāĻžāϰāĻĒāϰ (1+0+1).....ā§§āĻŽāĻžāϏāĨ¤
â Tab. Rivotril 0.5mg, (0+0+1)....ā§§ā§ĢāĻĻāĻŋāύāĨ¤
â Cap.Prenat XL, (0+1+0)....⧍āĻŽāĻžāϏāĨ¤
â Tab. Utramal RTD 50mg, (1+0+1).....ā§Ģ āĻĻāĻŋāύāĨ¤ (āĻāĻžāĻŦāĻžāϰ āĻĒāϰ, āĻŦā§āϝāĻžāĻĨāĻž āĻŦā§āĻļāĻŋ āĻĨāĻžāĻāϞā§)
â Tab. Othera 20mg, (1+0+1) (āĻāĻžāĻŦāĻžāϰ āĻāĻā§) ā§§ā§ĻāĻĻāĻŋāύāĨ¤
â Treatment of underlying causes
â If Not improved:
â Tab. Parixol 88mcg, (0+0+1)....ā§§āĻŽāĻžāϏāĨ¤
â āĻāĻĒāĻĻā§āĻļāĻ
â āύāĻŋā§āĻŽāĻŋāϤ āĻāώāϧ āĻāĻžāĻŦā§āύāĨ¤
â āĻĒāϰāĻŋāĻŽāĻŋāϤ āĻšāĻžāĻāĻžāĻāϞāĻž/ āĻŦā§āϝāĻžā§āĻžāĻŽ āĻāϰā§āύāĨ¤
â āĻŦā§āĻļāĻŋ āĻŦā§āĻļāĻŋ āĻĒāĻžāύāĻŋ āĻĒāĻžāύ āĻāϰā§āύāĨ¤
â āĻā§āύ āϏāĻŽāϏā§āϝāĻž āĻšāϞ⧠āĻĄāĻž. āĻĒāϰāĻžāĻŽāϰā§āĻļ āύāĻŋāĻŦā§āύāĨ¤