As Parkinson’s symptoms progress, increasing medications to address them can bring significant side effects. One of the most common and frustrating side effects of Parkinson’s medications is dyskinesia, uncontrollable movements of the arms and legs. Surgical therapies are explored after medications have been optimized and the side effects of adding more medications start to outweigh the benefits the medications provide. Current surgical therapies include deep brain stimulation and enteral suspension of carbidopa-levodopa.
Deep brain stimulation therapy (DBS) involves placing small electrodes into places in the brain affected by Parkinson’s. The wires emit continuous electrical impulses (stimulation) from a device similar to a heart pacemaker. These impulses positively affect the parts of the brain that influence movement and can improve many motor symptoms such as tremor, stiffness and slowness. DBS may also make daily activities like getting in and out of chairs, walking, dressing and bathing easier.
When the stimulator is working as it should, you will experience symptom control like you do when medications are ON, except you will need less or even no medications and ON periods may last longer, with less severe OFF periods.
Carbidopa-levodopa enteral suspension (Duopa®) is a gel form of the carbidopa-levodopa medication. This is the same basic medication found in many common Parkinson’s medications that work to replace dopamine lost in the brain.
The gel is infused directly into the small intestine through an internal tube. A small portable infusion pump is surgically connected to a part of the small intestine called the jejunum. The infusion pump administers the drug directly into the small intestine continuously over a period of 16 hours. Since the gel medication bypasses the stomach, it allows the medication to be more predictably and consistently absorbed throughout the day, which reduces fluctuations and the frustrating effects that can come during OFF periods.[/accordion-item]
When should I consider surgical therapy?
How do I learn more about these treatments?
Many of the members of your healthcare team can help you find the right approach to various treatment options, including neurologists, primary care providers, pharmacists, physician assistants and advanced practice nurses. Sometimes your doctor might try a combination of several strategies. It is important to communicate closely with your doctor, especially if the therapy isn’t working well or if you are experiencing any side effects so that you can try something else that might work better.
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