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Device-assisted and surgical treatments for Parkinson disease

Daniel Tarsy, MD
Section Editor
Howard I Hurtig, MD
Deputy Editor
John F Dashe, MD, PhD


As many as 50 percent of patients on levodopa for five years will experience motor fluctuations and dyskinesia [1]. These symptoms are especially common in patients with young-onset (eg, under the age of 50 years) Parkinson disease (PD). They are unique to levodopa and are not produced by the other antiparkinson drugs. (See "Pharmacologic treatment of Parkinson disease".)

Patients typically experience a smooth and even response to the early stages of levodopa treatment. As the disease advances, however, the effect of levodopa begins to wear off approximately four hours after each dose, leaving patients anticipating the need for their next dose. This phenomenon has been explained by the observation that dopamine nerve terminals are able to store and release dopamine early in the course of disease, but with more advanced disease and increasing degeneration of dopamine terminals, the concentration of dopamine in the basal ganglia is much more dependent upon plasma levodopa levels. Plasma levels may fluctuate erratically because of the 90-minute half-life of levodopa and the frequently unpredictable intestinal absorption of this medication. (See "Motor fluctuations and dyskinesia in Parkinson disease".)

Motor fluctuations are alterations between periods of being "on," during which the patient enjoys a good response to medication, and being "off," during which the patient experiences symptoms of the underlying parkinsonism. Dyskinesia consists of abnormal involuntary movements that are usually choreic or dystonic, but when more severe, may be ballistic or myoclonic. Dyskinesia usually appears when the patient is "on." They may occasionally occur in the form of painful dystonias when the patient is "off."

Device-assisted and surgical treatments for patients with advanced PD who are experiencing motor fluctuations will be reviewed here. The medical management of motor fluctuations associated with PD and levodopa therapy and the general approach to therapy of this disorder are discussed separately. (See "Motor fluctuations and dyskinesia in Parkinson disease" and "Pharmacologic treatment of Parkinson disease".)


For patients with levodopa-responsive PD who develop motor complications that compromise quality of life with noninvasive medical therapies, device-assisted treatment options include:

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Literature review current through: Nov 2017. | This topic last updated: Oct 31, 2017.
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