Device-assisted therapies for Parkinson disease.

Abstract

Device-assisted therapies for Parkinson disease include apomorphine continuous subcutaneous infusion, levodopa continuous intestinal gel infusion, levodopa continuous subcutaneous infusion and deep brain stimulation. These therapies have a role in managing motor fluctuations and dyskinesias in people with advanced Parkinson disease when symptoms are inadequately controlled with oral and transdermal treatments. Subcutaneous infusion of apomorphine or levodopa are the least invasive device-assisted therapies. Levodopa intestinal infusion is delivered via a surgically placed intestinal tube. Deep brain stimulation involves implanting electrodes into specific target regions of the basal ganglia to modulate brain activity. Selecting an appropriate device-assisted therapy depends on individual factors such as age, comorbidities, symptom severity and patient preferences. Initiation and management require neurologist and multidisciplinary involvement, typically in a specialist movement disorder centre. Primary care clinicians play a crucial role in ongoing support and management for people using these therapies, including monitoring and managing adverse effects and communicating with movement disorder services.