Hypokinetic rigid syndrome is a clinical syndrome presenting with any combination of bradykinesia (slowness of movement or speed) with rest tremor, rigidity, and postural instability. The most common form of hypokinetic rigid syndrome is Parkinson disease (PD), a chronic, progressive disorder caused by degenerative loss of dopaminergic neurons in the brain. The diagnosis PD is made by a neurologist and based on distinctive clinical features from the history and neurological examination. At a minimum, bradykinesia plus either (asymmetrical) tremor or rigidity must be present in order to consider the diagnosis of PD. Postural instability usually appears later in the course of PD. An unequivocal, beneficial response to dopaminergic therapy supports the diagnosis.
Hypokinetic rigid syndrome is also called parkinsonism. Parkinsonism with other causes than PD, e.g. medication-induced parkinsonism (antipsychotics, antiemetics), vascular parkinsonism or other rare causes, respond poorly to dopaminergic therapy.
Blood tests or radiologic imaging to confirm the diagnosis are not available. The GP refers a patient with (suspected) parkinsonism or PD to a neurologist or Parkinson expertise centre to confirm the diagnosis and startsymptomatic dopaminergic therapy. There is no cure for PD. In the Netherlands, over 3700 primary care and hospital professionals with expertise in parkinsonism collaborate closely in regional healthcare networks within the national ‘ParkinsonNet’ (www.parkinsonnet.nl). Within these networks, specialised nurses, physical therapists, occupational therapists and others provide daily care to patients and build multidisciplinary networks, leading to improved expertise and improved collaborations.