Fast Five Quiz: Management of Parkinson's Disease

Rajesh Pahwa, MD

Disclosures

January 13, 2022

For patients with dopamine-resistant symptoms such as motor fluctuations and dyskinesias, DBS is an alternative therapy for dopamine-responsive signs of disease.

Past randomized controlled trials have demonstrated the superiority of subthalamic nucleus (STN)-DBS over pharmacologic treatment in reducing motor complications and improving quality of life in patients with advanced disease. However, motor signs, including freezing, falling, and axial signs, do not show a marked improvement with DBS.

The UK National Collaborating Centre for Chronic Conditions notes that eligible patients for STN and globus pallidus internus are those without significant mental health problems such as depression and dementia. Depression is one of the most frequent nonmotor symptoms in Parkinson's disease in both early and advanced disease; it may even precede diagnosis.

Central to choosing appropriate patients for DBS is that the patient's symptoms are still responding to levodopa (despite the response not being adequately maintained through the day or complicated by dyskinesia).

Learn more about DBS.

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