A 59-year-old with Parkinson disease has disabling motor fluctuations and tremor despite optimised levodopa, adjunctive medicines and a trial of

Question

A 59-year-old with Parkinson disease has disabling motor fluctuations and tremor despite optimised levodopa, adjunctive medicines and a trial of apomorphine. Cognition and mood are satisfactory, and MRI shows no surgical contraindication. Which next option is most consistent with NICE guidance?

Accepted Answer

Refer for multidisciplinary DBS assessment because best medical therapy is no longer adequate

Answer

Continue the same regimen indefinitely because surgery is never used for medication-responsive symptoms

Answer

Withdraw levodopa and adjunctive medicines before referral to demonstrate untreated disease severity and surgical need

Answer

Proceed directly to bilateral DBS without multidisciplinary assessment because cognition is preserved and age is below 60

Answer

Replace apomorphine with long-term haloperidol to suppress tremor during ON periods before considering surgery

PD – CDS Goal — SCE Neurology MCQ

A 59-year-old with Parkinson disease has disabling motor fluctuations and tremor despite optimised levodopa, adjunctive medicines and a trial of apomorphine. Cognition and mood are satisfactory, and MRI shows no surgical contraindication. Which next option is most consistent with NICE guidance?