Parkinson's Disease Case Review & Coordination

• Neurology or movement disorder specialist reports, including date of diagnosis and diagnostic reasoning.
• Description of main motor symptoms: tremor, rigidity, bradykinesia, dystonia, freezing, gait difficulty, balance problems, falls, dyskinesia, and wearing-off.
• Non-motor symptom summary: sleep, mood, cognition, hallucinations, impulse control, autonomic symptoms, swallowing, speech, pain, fatigue, and constipation.
• UPDRS/MDS-UPDRS scores, Hoehn and Yahr stage, or other assessment scales if available.
• Short symptom videos, if already available, showing tremor, gait, freezing, dyskinesia, or on/off differences.

• Exact medication schedule with dose, timing, formulation, and how symptoms change during the day.
• Levodopa response history, including whether tremor, slowness, rigidity, dystonia, or gait improve after medication.
• Motor fluctuation diary or notes showing on-time, off-time, dyskinesia, dose failures, delayed on, early morning off, or night symptoms.
• List of previously tried medications and why they were stopped: side effects, lack of benefit, hallucinations, impulse control problems, hypotension, nausea, sleepiness, or dyskinesia.
• Advanced therapy history: apomorphine, intestinal levodopa gel, continuous levodopa infusion, DBS, MRgFUS, or previous lesioning procedures.

• Brain MRI report and DICOM imaging if DBS, MRgFUS, atypical diagnosis, structural lesions, or surgical planning are being considered.
• DaTscan / DaT-SPECT or other nuclear medicine reports if performed, especially when the diagnosis is uncertain.
• Neuropsychological assessment if DBS or complex advanced therapy is being considered.
• Psychiatric history, cognitive screening, hallucination history, impulse control disorder history, and current antidepressant/antipsychotic medication list.
• General medical information relevant to procedure risk: anticoagulation, cardiac history, infection risk, diabetes, previous brain surgery, pacemaker or implanted devices.

• Previous DBS operative reports, lead model, target, laterality, implantable pulse generator model, battery status, and date of implantation.
• Current and previous DBS programming settings, including active contacts, amplitude/current, pulse width, frequency, and side-effect thresholds if available.
• Programming history: what improved, what worsened, stimulation side effects, battery changes, hardware issues, infection concerns, lead revision, or loss of benefit.
• Medication schedule before and after DBS, including whether the goal is medication reduction, dyskinesia control, tremor control, or gait/function improvement.

• Physiotherapy, occupational therapy, speech-language therapy, swallowing assessment, gait training, or fall-prevention documentation.
• Current independence level, caregiver support, work status, daily activity limitations, driving, nutrition, and home safety concerns.
• Patient and family goals: tremor control, less off-time, less dyskinesia, medication reduction, better handwriting, walking, speech, swallowing, sleep, or caregiver burden.
• Local follow-up capacity: neurologist, movement disorder specialist, DBS programmer, rehabilitation provider, and family physician.

Advanced therapy review usually starts with diagnostic confidence. Specialist teams look for bradykinesia plus rest tremor or rigidity, the pattern of progression, response to levodopa, medication history, red flags for atypical parkinsonism, and whether imaging or DaTscan information supports the working diagnosis. This is important because DBS and other advanced therapies are generally planned for carefully selected Parkinson’s disease cases, not for every disorder that resembles Parkinson’s.

Many patients need review of medication timing, dose intervals, formulation, side effects, and non-motor symptoms before any procedural pathway is considered. The case file should show what has already been tried, which symptoms respond to levodopa, what remains disabling, and whether problems are due to under-treatment, wearing-off, dyskinesia, hallucinations, impulse control, orthostatic hypotension, sleepiness, or cognitive effects.

DBS review usually considers disease duration, levodopa responsiveness, disabling motor fluctuations, dyskinesias, tremor, medication goals, age and general medical risk, MRI suitability, cognitive status, psychiatric stability, caregiver support, and follow-up capacity. The clinical goal matters: STN and GPi DBS can both be considered for motor symptoms, but target selection may differ when medication reduction, dyskinesia control, cognitive risk, mood risk, or programming strategy is central to the case.

Some patients ask about MR-guided focused ultrasound for medication-resistant tremor. This pathway requires especially careful review because it is not simply a non-invasive substitute for DBS. Patient selection, tremor severity, laterality, cognitive and gait status, skull density and imaging suitability, lesioning risks, and long-term follow-up all need specialist assessment. For Parkinson’s tremor, some health systems still restrict MRgFUS to research or highly selected settings.

For advanced levodopa-responsive Parkinson’s disease, some patients may be assessed for continuous dopaminergic delivery such as apomorphine infusion, intestinal levodopa-carbidopa gel, or other levodopa infusion options depending on local availability and specialist judgement. These pathways require medication history, off-time/dyskinesia burden, cognition, caregiver support, device management ability, and follow-up infrastructure.

Parkinson’s care is not only medication and procedures. Balance, gait, freezing, posture, falls, swallowing, saliva, speech, daily activity and caregiver burden often require physiotherapy, occupational therapy, speech-language therapy, nutrition, home safety planning and local follow-up. A strong pathway should document what has been tried and what services are available after the international review or treatment.

DBS and other advanced therapies require structured follow-up. Patients may need repeated programming, medication adjustment, management of stimulation side effects, battery monitoring, rehabilitation, wound/device checks, and long-term communication between the operating center and local movement disorder team. This follow-up capacity should be considered before international treatment is organized.