Opinion|Videos|May 7, 2025

Advanced Treatment Options in Parkinson Disease

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.

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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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