[Don't let the patient with Parkinson's disease fall!].

Three patients with a hypokinetic-rigid syndrome, a woman aged 69 years and two men aged 62 and 67 years, were admitted because of frequent falling. In two patients Parkinson's disease was diagnosed, the third had progressive supranuclear palsy. Balance impairment and falls typically emerge late in the course of Parkinson's disease. Falls can have dramatic physical consequences, such as (hip) fractures, and often induce a fear of additional falls which further impairs mobility and social contacts. The pathophysiology of falls in Parkinson's disease is complex and appears to result from both impaired balance regulation and commonly occurring balance disturbances (due to the shuffling gait and dyskinesias). Balance impairment often responds insufficiently to pharmacological treatment. Aspecific measures such as physical therapy, walking aids and reduction of domestic hazards can reduce the number of falls. Because patients often fail to voluntarily report their falls, physicians must actively pay attention to balance impairment in Parkinson's disease.