A 66-year-old man with Parkinson's disease died from injuries sustained in a fall from his third-floor balcony. He had recently commenced Duodopa treatment via percutaneous endoscopic jejunostomy for motor fluctuations, which initially showed good response but caused daytime sleepiness. He was found deceased below his apartment balcony without his walking frame or medication belt. The coroner found insufficient evidence of suicide, and no evidence that Duodopa caused or contributed to death. However, the possibility that REM Sleep Behaviour Disorder associated with his Parkinson's disease may have contributed remains open. Clinically, this case highlights the importance of counselling patients starting novel Parkinson's treatments about potential sleep disturbances and fall risks, and ensuring adequate monitoring and safety precautions, particularly when new treatments alter mobility or consciousness.
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