When Parkinson’s disease has been managed with tablets for some time, some people begin to notice that their medication no longer provides the same level of symptom control. Stiffness may return sooner, involuntary movements may appear, or mobility may fluctuate throughout the day.
When this happens, it can be worrying. Many people wonder whether treatment options are running out or whether the condition is progressing more quickly.
In reality, several additional therapies are available when tablets alone are no longer enough. These advanced treatments are carefully considered and tailored to each individual, and understanding how they work can help patients feel more informed and reassured.
What are the advanced treatment options for Parkinson’s disease?
Advanced treatments are considered when symptoms are no longer well controlled with tablets alone.
The main options include:
- Deep brain stimulation (DBS) — a surgical treatment
- Continuous medication infusion therapies — pump-based treatments that deliver medication steadily throughout the day
Some advanced therapies involve surgery, such as DBS. Others use less invasive approaches, including small injections or pump-based systems that provide continuous medication delivery.
These approaches aim to smooth out symptom fluctuations and improve overall stability throughout the day.
Advanced treatments are not one-size-fits-all. The choice depends on:
- The pattern of symptoms
- Response to levodopa and other medication
- Lifestyle and daily routine
- Overall physical and mental health
- Personal preferences
A full specialist assessment is required to determine whether advanced therapy is appropriate, and which option is most suitable. This personalised approach helps ensure treatment is used safely and effectively to improve symptom control and quality of life.
When should deep brain stimulation (DBS) be considered?
Deep brain stimulation is usually considered when:
- Motor symptoms significantly affect quality of life
- Medication fluctuations become difficult to manage
- Troublesome dyskinesia develops despite optimised treatment
It is most often discussed after several years of Parkinson’s disease, once the pattern of symptoms and treatment response is clearer.
Before DBS is offered, a thorough assessment is required. This includes evaluation of:
- Motor symptoms
- Non-motor symptoms
- Cognitive function
- Mental health
- Responsiveness to medication
Imaging and additional specialist assessments are also part of this process.
Importantly, DBS assessment is carried out within a multidisciplinary team (MDT), involving neurologists, neurosurgeons, specialist nurses and allied health professionals. It is never a standalone or rushed decision.
Who is a good candidate for deep brain stimulation (DBS)?
A good candidate for surgery is typically someone who:
- Responds well to levodopa
- Experiences troublesome motor fluctuations or dyskinesia
- Has medication-related side effects that significantly affect daily life
- Does not have significant cognitive impairment
- Does not have uncontrolled psychiatric illness
The decision to proceed with surgery is rarely based on a single clinic visit. It usually requires careful observation over time and detailed assessment by a multidisciplinary team (MDT), including neurologists, specialist nurses, neuropsychologists and neurosurgeons.
This collaborative approach ensures surgery is offered to the right person, at the right time, with a clear understanding of potential benefits and risks.
Do advanced therapies help with tremor and movement problems?
Yes. Advanced therapies can significantly improve tremor, stiffness, slowness of movement and motor fluctuations. Many people experience smoother symptom control throughout the day and reduced reliance on frequent medication dosing.
These treatments can improve daily functioning and confidence.
However, advanced therapies do not replace all other aspects of care. Most people will still require some oral medication, and broader lifestyle support remains important.
Regular exercise, good sleep, balanced nutrition, stress management and physiotherapy continue to play a crucial role in maintaining long-term physical and mental wellbeing alongside advanced treatments.
How does DBS compare to medication?
Deep brain stimulation does not cure Parkinson’s disease and does not eliminate the need for medication. However, when medication alone is no longer sufficient, DBS can provide more stable symptom control, reduce fluctuations and improve quality of life.
As with other advanced therapies, DBS does not replace the broader aspects of care. Most patients will still require some oral medication, and lifestyle measures remain important.
Regular exercise, good sleep, balanced nutrition, stress management and physiotherapy continue to support long-term outcomes alongside advanced treatment.
What to remember
When Parkinson’s medication stops working consistently, it does not mean there are no further options.
Advanced treatments, including deep brain stimulation and continuous infusion therapies, can significantly improve symptom control when carefully selected. A detailed specialist assessment within a multidisciplinary team ensures the right treatment is offered at the right time.
With appropriate support, many people achieve better stability, improved function and greater confidence in daily life.
About the author
Dr Kit Wu is an award-winning Consultant Neurologist specialising in movement disorders and general neurology, practising at King’s College Hospital NHS Foundation Trust and The Wellington Hospital. She is a member of the Parkinson’s Disease Centre of Excellence at King’s College Hospital, one of only two centres in the UK recognised for excellence in Parkinson’s care and research. Dr Wu holds a PhD in Neurosciences from Imperial College London and is recognised for her work improving access to healthcare for diverse communities.
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