The factors involved in management of advanced Parkinson’s Disease:

• Lack of time to properly determine the patient’s response to 1st line therapies
• Difficulty in getting 2nd-line therapies or in referring patients to a movement disorders unit
• Lack of experience, or patient’s refusal.

Sometimes, the neurologist may need to combine DBS with an infusion therapy or treat the patient with two different 2nd line treatments.

Dr Ángel Sesar-Ignacio

Department of Neurology, Movement Disorder Clinic, Complejo Hospitalario Universitario de Santiago de Compostela, Santiago de Compostela, Spain.