Movement disorders including Parkinson’s disease and dystonia

Referrers should use this page when referring patients to public adult neurology outpatient services for movement disorders including Parkinson's disease, dystonia and essential tremor. 
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

Emergency referral
If any of the following are present or suspected, refer the patient to the emergency department or seek emergency medical advice if in a remote region.
  • Sudden movement disorder involving ocular movement
Immediate referral
Orange exclamation mark in triangle: orange alertImmediately contact on-call registrar or service to arrange immediate neurological assessment (seen within 7 days):
  • Severe symptoms or abrupt onset/deterioration of movement disorder
To contact the relevant service, see HealthPathways: Acute Neurology Assessment (external site)
Presenting issues
If any of these issues are present, refer to outpatient services through the Central Referral Service (CRS).
  • 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 information
Referrals missing 'mandatory information' with no explanation provided may not be accepted by site. If 'mandatory information' is not included, the explanation must be provided in the body of the referral (e.g. patient unable to access test due to financial reasons or geographical location).

This information is required to inform accurate and timely triage. If unable to attach reports, please include relevant information/findings in the body of the referral and advise where (provider) investigation/imaging was completed.

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)
Examination
  • Nil
Investigations
  • TSH for tremors           
Highly desirable
History
  • Detailed history of abnormal movements
  • 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         
Examination
  • Nil
Investigations
  • 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
Indicative triage category

Category 1

Appointment within 30 days

  •  No defined category 1 criteria

Category 2

Appointment within 90 days

  • Known or suspected:
    • Parkinson Disease (<65 years)
    • Dystonia
    • Myoclonus
    • Huntington’s disease
    • Tardive dyskinesia          

Category 3

Appointment within 365 days

  •  Non-progressive movement disorder i.e. essential tremor 
Exclusions
  • Nil
Useful information
  • Nil             
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