63 yrs old parkinsomism

 My 3rd case 

63 yrs old male patient farmer by patient occupation came to OPD with

Chief complaints: fine involuntary movements involving left hand and foot in 3 years

History of presenting illness: he was apparently asymptomatic 3 years ago and then developed involuntary movements on left hand and leg which are in serious in on set slowly progressive in nature that is members was initially at rest and now present even with active movement since one year 

Generally aggravated on talking and emotional stress there is definition of tremors when he asleep

There are delay in initial moments no difficulty in getting up from lifting position or eating aur button

Medical history no history of diabetes no history of hypertension no history of tuberculosis no history of epilepsy no history of asthma

Fast history e t has a history of trauma 20 years ago

Family history his mother has a similar history

Personal history diet mixed sleep adequate appetite normal ball and bladder normal alcohol habit waited

General examination he is conscious and cooperative moderately built and moderate in there are no signs of pickle

Vitals temperature referral respiratory rate 78 BPM blood pressure 130 by 80 mm of HG pulse rate normal

CNS examination higher mental functions he is conscious well oriented to time place and person his speech is normal and he is able to communicate and Express he has a good immediate response and affection he is right handed neck rigidity rigidity and connection or absent

Motor functions attitude normal nutrition no waiting tone normal muscle power norm

Involuntary movements starting with rest ing tremor  and increases0

I am the diagnosis parkinsonism treated dopamine  antagonist