Table 1

Illustrating how specific complications of the disease process and documented adverse effects of previous drug therapy may influence the decision to use device-aided therapy

ApomorphineLevodopa/carbidopa intestinal gelDeep brain stimulation
Age over 70 years++
Presence of comorbidities+
Severe speech disturbance++
Postural instability, falls00
Hallucinations/psychosis0++
Impulse control disorders0++
Excessive daytime sleepiness00
Mild dementia00
Moderate–severe dementia
Moderate–severe depression++
Previous suicide attempts00
Dysphagia++
Weight gain00
Restless legs++0
  • +=Presence of side effect/complication strengthens the decision to select the device-aided therapy.

  • 0=Presence of side effect/complication does not influence the decision.

  • −=Presence of side effect/complication argues against selecting the device-aided therapy.

  • The table is based largely upon clinical experience and expert opinion in the absence of published robust comparative evidence.