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