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CONy 2021 | Should device-aided treatment be given earlier in Parkinson’s disease?

Zvezdan Pirtosek, MD, PhD, Ljubljana University Medical Centre, Ljubljana, Slovenia, argues against the earlier intervention of device-aided therapies (DTAs) in Parkinson’s disease (PD) patients. Apomorphine pumps, intraduodenal gel-based levodopa, and deep brain stimulation (DBS) are some examples of DTAs. These treatments are similar in that they require highly skilled teams to be delivered, they are expensive and associated with relatively burdensome side effects. Whilst effective, this makes it impractical to deliver DTAs at a large scale. Additionally, PD patients at earlier disease stages may not permit the increased side effects. Moreover, it is difficult to distinguish the stage of disease between patients and to predict disease trajectory. Furthermore, less invasive DTAs, as well as potentially disease-modifying therapies, are in development. Future studies comparing the different DTAs in PD are required. This interview was conducted during the virtual 2021 World Congress on Controversies in Neurology (CONy) meeting.