Treatment of advanced Parkinson's disease

Currently, deep-brain stimulation is the most commonly used invasive treatment method in the world. In 2017, we were the first hospital in Finland to implement the directional electrode, which reduces the DBS-related adverse effects, such as speech difficulties, even better than before. In deep-brain stimulation, the electrodes, wires, and the generator are placed under your skin. When necessary, you can adjust the stimulator with your own programmer device. However, with the stimulator optimally programmed, there is no need for you to perform any daily adjustments. Deep-brain stimulation reduces tremor, motor fluctuations, and involuntary movements significantly better than optimized medicinal therapy. At best, the response lasts for over 10 years. In our unit, the stimulators are currently installed under general anesthesia.  

In levodopa infusion therapy, an external pump is used to administer levodopa gel to the small intestine. You can adjust the infusion speed according to the response. Levodopa infusion has been shown to significantly reduce daily off-phases and increase on-phases when compared to regular medication. ‘Off’ phase means a time when the levodopa medicine wears off and the symptoms increase after an ‘On’ phase. This treatment is useful for patients with motor fluctuations or involuntary movements who still clearly respond to levodopa treatment. According to our experience, the response to this therapy optimally lasts at least 10 years..

Apomorphine is a dopamine agonist, and despite its name, has no opiate effects. Apomorphine alleviates motor symptoms about as much as levodopa does. An apomorphine injection has a rapid onset time, even as quick as 10 minutes.

Apomorphine infusions have been shown to significantly reduce daily off-phases. It is especially suited for patients for whom apomorphine pens are verifiably suitable and who require more than five injections a day. However, it is also possible to proceed directly to the infusion without using the pen first.  

Both levodopa and apomorphine infusions may be suitable options if the patient has some contraindications for deep-brain stimulation, such as balance or speech difficulty that does not respond to levodopa, or the patient is afraid of the risks related to brain surgery.