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Carbamazepine-Rivaroxaban – DOAC Interaction — SCE Neurology MCQ

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HardEpilepsy & Seizure DisordersCarbamazepine-Rivaroxaban – DOAC InteractionSCE Neurology

A 61-year-old with idiopathic Parkinson disease has severe levodopa-responsive off periods and dyskinesia despite optimised oral therapy. Cognition and MRI are suitable for surgery. Apomorphine previously caused profound hypotension, prior gastric surgery precludes PEG-J delivery, and severe adhesive dermatitis makes a continuous subcutaneous pump impractical. Which advanced assessment is most appropriate?

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Correct answer: C — Refer for deep-brain-stimulation assessment by the movement-disorders team

NICE recommends considering deep-brain stimulation when advanced levodopa-responsive Parkinson disease is inadequately controlled by best medical therapy. Each infusion alternative is a genuine advanced option in an appropriate patient, but the stem supplies a material contraindication or prior intolerance to its route: apomorphine caused severe hypotension, PEG-J delivery is not feasible, and adhesive intolerance undermines continuous subcutaneous delivery. Preserved cognition and suitable imaging support surgical assessment.

Reference: NICE NG71 Parkinson disease in adults: recommendations (Current NICE recommendations, accessed July 2026): https://www.nice.org.uk/guidance/ng71/chapter/Recommendations