Stiff 2

A 57 year old woman presents with a 3 year history of worsening difficulty with fine movements of her right hand and stiffness in her right shoulder.

During this time period, she developed a rest tremor in her right hand, which spread to involve her right arm and leg and is now present on movement as well.

Over time she has become slow in her work and finds it difficult to maintain balance and turn in bed. She finds her daily activities to be a burden and has retired early.

Her medical history is unremarkable and she is not on any drugs.

Select Relevant Investigations
Mini Mental State Examination


The MMSE score is 25 points (normal: >24)
MRI brain


The MRI of the brain appears normal.
Levodopa Challenge


There is clinically significant improvement in the Unified Parkinson Disease Rating Scale (UPDRS) one hour after administration of oral carbidopa/levodopa.


The EEG appears to be normal.

Select Relevant Management
Levodopa + Carbidopa
Dopamine Agonists
High-fibre Diet