Most patients with paralysis agitans (Parkinsonism) are easy to treat. Those with tremor in an arm or leg, who continue at work or household duties, can be maintained comfortably by suitable medication and physiotherapy for as long as 10, 20, or 30 years, until serious progression of symptoms occurs.1 There are patients, nevertheless, who present problems that severely tax the ingenuity and patience of the physician but can be managed with greater effectiveness if their problems are better understood. These problems will be discussed under three major headings: (1) problems related to the symptoms of paralysis agitans, (2) problems related to the personality of the patient, and (3) problems related to intercurrent ailments.
PROBLEMS RELATED TO THE SYMPTOMS OF PARALYSIS AGITANS
Rigidity is generally not difficult to manage, since there are ample antispasmodics to counteract it.2 However, neglect of treatment, or the natural progression of illness in