Objective: To assess the spectrum of clinical complaints and disorders at an Urgent Care Movement Disorders clinic.

Background: Movement disorders patients not infrequently require urgent clinic visits. While this has not been studied, the literature suggests that a majority of such visits relate to motor and non-motor symptoms in Parkinson’s disease (PD). At the Emory University Movement Disorders Clinic, an Urgent Care Clinic (UCC) addresses urgent concerns as they arise between scheduled visits. This provided an opportunity to study the spectrum of urgent symptoms in these patients.

Methods: UCC visits are triaged and scheduled by a trained nurse with the support of a movement disorder neurologist. We performed a retrospective record review of patients evaluated at UCC between September 2014 and December 2015. Patients were stratified according to the primary diagnosis and their primary complaint. We divided patients into those with ‘disease related’ or ‘non-disease related’ etiologies. ‘Disease related’ etiologies were defined as issues considered as manifestations of disease progression or medication complications. ‘Non-disease related’ etiologies included any other causes not primarily related to the disease.

Results: Thirty-six patients were seen in the UCC (mean age 71 years, SD 8.85), and 72% were male. The primary diagnoses of patients were PD (77.7%), Lewy body disease (11.1%), progressive supranuclear palsy (5.6%) and tardive dyskinesia (5.6%). Reasons for urgent presentation included motor fluctuations (31%), increased frequency of falls (25%), hallucinations (25%), worsening cognition (14%), gait impairment (11%), chorea (6%), and medication side effect (6%). Among patients with PD, falls and motor fluctuations were the most common ‘disease-related’ etiologies (68%), whereas urinary tract infection was the most common ‘non-disease related’ etiology.

Conclusions: The development of a UCC provided an opportunity to examine etiologies of urgent movement disorder related visits. We confirmed that PD is the most common disorder and that the most frequent complaints include motor complications, falls and hallucinations. Urinary tract infections and medication side effects were common etiologies. Tardive dyskinesia was the only non-Parkinsonian disorder to require urgent visits. This topic requires further prospective study to develop plans for access and prevention.

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MDS Abstracts - https://www.mdsabstracts.org/abstract/profile-of-urgent-care-visits-in-movement-disorders/