Individualizing Advanced Therapies in Parkinson Disease: Hubert Fernandez, MD

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“When the dyskinesias are bothersome, when the ‘off’ periods are more than 3 hours or so, or when patients have tried various medications and are unable to tolerate them or unable to relieve their motor fluctuations, these are the red flags that, when we see them, we start entertaining the possibility of offering device-aided therapy.”

As treatment options for Parkinson disease (PD) continue to expand, clinicians face ongoing challenges in determining when patients should transition from oral medications to device-aided therapies and how to select the most appropriate approach. Although adjunctive oral therapies may initially help manage motor fluctuations, some patients eventually continue to experience substantial OFF time despite medication adjustments. At that stage, options may include infusion therapies delivered through the gastrointestinal tract or subcutaneously, deep brain stimulation (DBS), and focused ultrasound, each with distinct advantages, limitations, and patient-selection considerations.

In his plenary presentation at the 2026 International Congress of Parkinson’s Disease and Movement Disorders (MDS), held October 4-8 in Seoul, South Korea, Hubert Fernandez, MD, director of the Center for Neurological Restoration and head of Movement Disorders at Cleveland Clinic, addressed the evolving role of advanced therapies in PD. His discussion highlighted the need to better identify patients who may benefit from these approaches, particularly as treatment options continue to develop and access to device-aided therapies varies across health care settings.

In an interview with NeurologyLive®, Fernandez examined several outstanding questions surrounding the use of device-aided therapies, including how real-world outcomes can help clarify when patients should transition beyond oral treatment and how clinicians can better address differences in access. He also discussed practical considerations associated with infusion therapies, including the maintenance requirements of gastrointestinal delivery systems and the potential skin-related burden of subcutaneous infusions.

For more 2026 MDS coverage, click here. For more Parkinson coverage, click here.