In the Clinic is a monthly feature in Annals of Internal Medicine introduced in January 2007 that focuses on practical management of patients with common clinical conditions. It offers evidence-based answers to frequently asked questions about screening, prevention, diagnosis, therapy, and patient education and provides physicians with tools to improve the quality of care.
Parkinson Disease
Parkinson disease is a common neurodegenerative disorder that causes progressive motor and nonmotor disability. It is diagnosed clinically and requires a detailed history and neurologic examination to exclude alternative diagnoses. Although disease-modifying therapies do not exist for Parkinson disease, effective symptomatic therapies, including dopaminergic medications and surgery, allow patients to maintain good quality of life for many years. Nonmotor symptoms, including mood, cognitive, sleep, autonomic, and gastrointestinal symptoms, should be managed by a multidisciplinary team of clinicians. Recent advances include new diagnostic criteria from the Movement Disorder Society and the addition of new symptomatic therapies for treating motor complications and nonmotor symptoms in advanced disease.
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Herpes Zoster
Primary care providers and hospitalists frequently encounter older or immunocompromised patients with herpes zoster accompanied by debilitating pain. Atypical presentations and zosteriform herpes simplex may present diagnostic challenges to clinicians. This article summarizes the background, evidence, and guidelines for the diagnosis, complications, treatment, and prevention of herpes zoster. Diagnosis of challenging cases relies on polymerase chain reaction as the preferred test. Treatment focuses on optimal use of antiviral therapy and analgesics. Prevention emphasizes utilization of a new recombinant zoster vaccine, which reduces the incidence of herpes zoster by more than 90% and is preferred to the live attenuated herpes zoster vaccine.
. All ACP members have full access to this content.