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Currently, there are two surgical treatments available for people living with Parkinson’s disease — deep brain stimulation (DBS) and surgery performed to insert a tube in the small intestine, which delivers a gel formulation of carbidopa/levodopa (Duopa™).
DBS surgery was first approved in 1997 to treat Parkinson’s disease tremor, then in 2002 for the treatment of advanced Parkinson's disease symptoms. More recently, in 2016, DBS surgery was approved for the earlier stages of Parkinson's, for those with at least four years disease duration and with motor complications that are not adequately controlled with medication.
In deep brain stimulation, surgery is performed to insert electrodes into a targeted area of the brain, using MRI and recordings of brain cell activity during the procedure. A second procedure is performed to implant an impulse generator or IPG (similar to a pacemaker) under the collarbone or in the abdomen. The IPG provides an electrical impulse to a part of the brain involved in motor function. Those who undergo DBS surgery are given a controller to turn the device on or off.
DBS is certainly the most important therapeutic advancement since the development of levodopa. It is most effective for individuals who experience disabling tremors, wearing-off spells and medication-induced dyskinesias, with studies showing benefits lasting at least five years. That said, it is not a cure and it does not slow PD progression. It is also not right for every person with PD.
Like all brain surgeries, DBS carries a small risk of infection, stroke, bleeding or seizures. DBS surgery may be associated with reduced clarity of speech. A small number of people with PD have experienced cognitive decline after DBS surgery.
It is very important that a person with PD who is thinking of DBS surgery be informed about the procedure and realistic in his or her expectations.
Carbidopa/levodopa enteral suspension (Duopa™) is a gel formulation of the gold-standard drug used to treat the motor symptoms of Parkinson’s. It is indicated for the treatment of motor fluctuations in advanced Parkinson’s.
The drug is delivered to the small intestine through a tube in the stomach. Surgery is required to place a small hole in the stomach that allows for drug delivery.
DUOPA™ uses the same active ingredients as orally-administered carbidopa/levodopa, but is designed to improve absorption and reduce off-times by delivering the drug directly to the small intestine.
Like any surgery, the procedure carries risks, as does use of the device that delivers the drug. These include movement or dislocation of the tube, infection, redness at the insertion point, pancreatitis, bleeding into the intestines, air or infection in the abdominal cavity, and failure of the pump. The drug may also lead to side effects. The drug is contraindicated for those taking nonselective monoamine oxidase (MAO) inhibitors.