Skip to main content

Parkinson's disease and tremor referral pathway

This is a referral pathway for patients who have Parkinson’s disease (PD) and atypical parkinsonian syndromes (APS):

  • Multi-system atrophy (MSA)
  • Progressive supranuclear palsy (PSP)
  • Cortico-basal degeneration (CBD) 
  • Dementia with Lewy Bodies (DLB)

Some medications can cause a tremor, other movement disorders or parkinsonism (slow movements and balance problems that come with PD). These patients are also covered in this pathway.

Not everyone with PD has tremor, but this is the most well-known feature and this pathway deals with patients with tremor. The majority of people with tremor do not have PD, they have a condition called essential tremor (ET).

Patient is known by the PD and movement disorders teams

Guidance on managing PD and a selection of frequently asked questions are available on the following pages:

The Movement Disorders Service at University Hospitals Birmingham comprises of:

  • Neurologists
  • Geriatricians (from the Healthcare of Older People department) 
  • PD nurses

Patients with PD and APS are often supported by community nurses who are employed by a variety of different trusts. It is usually best to contact the PD nursing team before contacting the medical team.

The medical secretary team can be contacted via the switchboard of the relevant hospital.

Enquiries can also be submitted through the advice and guidance process.

When contacting the team, please includign the following details:

  • Which doctor the patient usually sees in clinic
  • What medication the patient is taking:
    • Name
    • Dose
    • Times

New patient with tremor or suspected PD, APS or drug-induced movement disorder

Patients should be referred to their local secondary care provider. Most district general hospitals have health care of older people (HCOP) departments and Neurologists.

New referrals should be made through the advice and referral process. Please include all of the relevant information as outlined on the 'How to make a good Neurology referral' page.

Patients who are:

  • 75 years or older should be referred to HCOP
  • younger than 75 years should be referred to Neurology

Movement disorder diagnoses are usually purely clinical, but occasionally patients will need imaging (CT, MRI or DaT scan) or blood tests.

We try to see patients as quickly as we can, but while the patient is awaiting assessment you can try appropriate treatment for PD or ET. You can also view the making a diagnosis guidelines in the table below.

Making a diagnosis guidelines

Feature Parkinson’s disease Essential tremor
Bradykinesia (finger tapping) Get’s slower, smaller and the rhythm breaks down Maintains consistent frequency, amplitude and rhythm
Tremor type Resting: ‘put your hands on your knees, close your eyes and count backwards from 30’ Positional: ‘hold your arms out straight’
Tremor frequency Slow Fast
Tremor amplitude Coarse Fine
Other features
  • Stiffness in wrist joints on examination
  • Loss of arm-swing (usually on one side when walking)
  • Micrographia (writing gets smaller towards the end of the sentence)
  • Low blink rate and/or frontalis over activity ‘surprised stare’
 'Ten past eight’ wobble when drawing a spiral

More on this

Other websites

Last reviewed: 11 August 2025