Opinion|Videos|May 7, 2025

Advanced Treatment Options in Parkinson Disease

Author(s)Stuart H. Isaacson, MD, FAAN
Daniel E. Kremens, MD, JD

Panelists discuss how physicians typically consider advanced Parkinson disease treatments when conventional therapies fail to adequately control motor fluctuations, highlighting challenges such as adverse effects, device-related complications, and patient selection criteria.

Video content above is prompted by the following:

Advanced Treatment Considerations and Challenges

Timing for Advanced Treatment Consideration:

When standard oral medications fail to adequately control motor fluctuations
When optimal oral therapy causes intolerable adverse effects
When quality of life is significantly impacted despite medication optimization
Usually 5 to 10 years into disease course
When off time exceeds 2 hours daily despite optimization

Challenges With Current Treatment Options:

Narrow therapeutic window of levodopa (balancing efficacy vs dyskinesias)
Pharmacokinetic limitations of oral medications
Gastrointestinal dysfunction affecting medication absorption
Cognitive decline limiting complex medication regimens
Peripheral adverse effects (orthostasis, nausea, impulse control disorders)
Patient adherence to complex regimens
Surgical interventions: patient selection criteria, resource limitations, expertise availability
Cost and insurance coverage barriers for advanced therapies

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