A clinical “decision tree” used for determining which treatments are appropriate for specific symptoms and the course of disease. Symptoms vary so widely among people with Parkinson’s that establishing a standard treatment protocol is impossible. Neurologists follow general guidelines that consider symptom clusters, the disease’s stage, the risks of side effects, and a therapeutic windows of opportunity for optimal relief. Much of the process is continual adjustment to keep pace with the changing pathological processes of Parkinson’s as it progresses, variable response to treatments, treatment resistance, and the person’s ability to tolerate specific anti-parkinson’s medications. The most effective approach to treatment decisions is based on collaboration between the physician and the person with Parkinson’s.
Although levodopa is the cornerstone of medical treatment of Parkinson’s, people respond to it in different ways at different points in the disease process. It becomes important to present a balance of approaches that provide optimal relief from the range of primary and secondary symptoms. Other medications, and for some people, surgical interventions such as THALAMOTOMY, PALLIDOTOMY, or deep brain stimulation (DBS), offer unique benefits and risks for each individual.