A 68-year-old man with Parkinson's disease on levodopa-carbidopa develops unpredictable off periods, dyskinesias, and motor fluctuations despite optimized oral therapy. According to current movement disorder society guidelines, which intervention is specifically indicated for this scenario?
- A Adding entacapone (COMT inhibitor) to reduce wearing-off
- B Switching to dopamine agonist monotherapy (pramipexole)
- C Deep brain stimulation (DBS) of subthalamic nucleus or globus pallidus interna ✓
- D Starting amantadine for neuroprotective effect
Explanation
Deep brain stimulation (DBS) is the gold-standard surgical intervention for advanced Parkinson's disease with medically refractory motor fluctuations and dyskinesias. Targets include subthalamic nucleus (STN) or globus pallidus interna (GPi). The EARLYSTIM trial suggested DBS may even benefit patients in earlier stages with motor complications (4 years duration). DBS reduces off time by ~50%, dyskinesias by 60–70%, and improves quality of life. DBS does not help non-motor symptoms (dementia, autonomic, psychiatric). Adding entacapone is useful for mild wearing-off early in the course. Amantadine is used for dyskinesia management but not motor fluctuations per se. Dopamine agonist monotherapy would reduce levodopa benefit.
Reference: Harrison's Principles of Internal Medicine, 21st ed.
High-yield for: NEET PGINI-CETNExTFMGEUSMLEPLABMRCP
Written and medically reviewed by the StethoPrep medical team.