How to use the new EAN/MDS‐ES guideline for invasive therapies in Parkinson's disease

Background

The decision to choose invasive treatments for Parkinson's disease (PD) is complex and needs careful consideration.

Objektives

Although the recommendations of the EAN/MDS‐ES guideline for invasive therapies of PD are useful, the different clinical profiles of people with PD who seek advice for possible invasive therapy need further attention.

Methods and Results

Here we describe eight clinical standard situations of people with PD unsatisfied with their current oral treatment where invasive therapies may be considered. These are PD patients presenting with (1) severe motor fluctuations, (2) beginning of levodopa‐responsive fluctuations, severe tremor at (3) young or (4) advanced age, (5) impulse control disorders and related behavioural disorders, (6) hallucinations and psychosis, (7) minimal cognitive impairment or mild dementia and (8) patients in palliative care need. For some of these conditions evidence at lower level or simple clinical considerations exist.

Conclusions

There are no one‐fits‐all answers, but physician and patient should discuss each option carefully considering symptom profile, psychosocial context, availability of therapy alternatives, and many other factors. The current paper outlines our proposed approach to these circumstances.

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