Treatment strategies and future perspectives for Parkinson disease in the “Device Aided Therapy Era”

Abstract

Device Aided Therapy (DAT) is a strong and well–established treatment option to manage the advanced stages of Parkinson Disease. DAT includes deep brain stimulation (DBS) and pump therapies including levodopa–carbidopa intestinal gel therapy (LCIG), continuous subcutaneous injection of foslevodopa and foscarbidopa, and continuous subcutaneous injection of apomorphine. DAT and Other surgical procedures such as thermal coagulation and MR guided focused ultrasound (MRgFUS) are sometimes classified as invasive therapies. DAT is now the standard treatment option for treatment–resistant involuntary movements and motor complications in patients with advanced Parkinson disease. The strengths and weaknesses of each therapy must be evaluated, and long–term strategies after the introduction of each therapy must also be considered. Indications for each treatment do not appear rapidly at a certain point in the disease progression and disappear suddenly at a certain point, but the degree of recommendation and expected therapeutic benefit vary continuously. In addition, the time when drug therapy can be used and the optimal time for invasive therapies such as DAT sometimes overlap. In addition to recommendations based on symptoms and condition, it is important to make a comprehensive judgment of the patient's environment, the presence of caregivers, and the medical situation in the community, and to propose treatment options.