Rationale and patient selection for interventional therapies in Parkinson’s disease

Junaid Siddiqui, Zakiyah Aldaajani, Raja Mehanna, Barbara Kelly Changizi, Danish Bhatti, Ziyad Ghazi Al-Johani, Aparna Wagle Shukla, Hubert H. Fernandez, Jawad A. Bajwa

Research output: Contribution to journalReview articlepeer-review

9 Scopus citations


Introduction: Parkinson’s disease (PD) is increasing in prevalence due to a growing elderly population. Although there is no cure, there are exercise therapies and medications for mild to moderate disease. For more advanced disease, infusion or surgical interventions including deep brain stimulation surgery, levodopa carbidopa intestinal gel, and subcutaneous apomorphine infusion are considered. As these interventions become increasingly available, it is imperative for a neurologist involved in the care of advanced PD to be aware of the indications and timing for these interventions. Areas covered: This article attempts to identify different patient profiles and matches them with suggested advanced therapies for PD. There is limited literature providing guidance to a busy neurologist to match the most appropriate advanced therapy to the right patient profile. This article attempts to fill that void. Expert commentary: When matching patient profiles to therapy, several features must be considered: age, frailty, cognitive status, phenotype (predominant tremor vs. akinetic rigid), side effect or complication profile (dyskinesia, hallucinations, dysautonomia), and patient’s comfort with invasive therapy options.

Original languageEnglish (US)
Pages (from-to)811-823
Number of pages13
JournalExpert Review of Neurotherapeutics
Issue number11
StatePublished - Nov 2 2018


  • Parkinson’s disease
  • advanced therapies
  • deep brain stimulation
  • levodopa carbidopa intestinal gel
  • subcutaneous apomorphine infusion

ASJC Scopus subject areas

  • General Neuroscience
  • Clinical Neurology
  • Pharmacology (medical)


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