Parkinson’s DBS Second Opinion with Prof. Loránd Erőss

• Recent neurology or movement disorder report, including the current diagnosis and neurological status.
• Main motor symptoms: tremor, rigidity, slowness, dystonia, freezing, gait difficulty, falls, dyskinesia and wearing-off.
• Relevant non-motor symptoms: cognition, mood, hallucinations, sleep, impulse control, autonomic symptoms, swallowing and speech.
• MDS-UPDRS or UPDRS scores, Hoehn and Yahr stage and other clinical scales, if available.
• Short videos showing tremor, walking, freezing, dyskinesia or on/off differences, if already available and transferred through the secure route requested by Healwise.

• Exact current medication schedule with drug name, dose, formulation and timing.
• Formal levodopa challenge or levodopa-test results where available.
• If no formal test is available: a detailed account of which symptoms improve after levodopa, how long the benefit lasts and which symptoms do not respond.
• On/off diary or notes showing off-time, dyskinesia, dose failures, delayed-on and night or early-morning symptoms.
• Previously tried treatments and the reason each was stopped or changed.

• Recent brain MRI report and DICOM images where available.
• DaT-SPECT or other nuclear medicine reports if performed.
• Neuropsychological assessment, cognitive screening and relevant psychiatric history if advanced therapy is being considered.
• Medical history relevant to procedure risk, including anticoagulation, cardiac disease, infection risk, diabetes, previous brain surgery, pacemaker or other implanted devices.
• Any previous DBS, MRgFUS or advanced-therapy assessment.

• Operative report, target, side, lead model, pulse-generator model and implantation or battery-change dates.
• Current and previous programming settings, if available.
• Programming history: benefit, stimulation side effects, loss of effect, battery or hardware concerns and previous revisions.
• Medication schedule before and after DBS and the current review goal.

• Current independence, caregiver support, work and driving status, falls and daily activity limitations.
• Physiotherapy, occupational therapy, speech or swallowing assessments where relevant.
• Priorities such as reducing off-time, dyskinesia or tremor; improving function; or reducing medication burden.
• Available local follow-up: neurologist, movement disorder specialist, DBS programmer, rehabilitation provider and family physician.

The review can consider whether the reported clinical pattern is consistent with Parkinson’s disease, whether there are red flags for atypical parkinsonism, which disabling symptoms appear levodopa-responsive and which problems are less likely to improve with DBS.

The specialist may identify whether the submitted information supports proceeding to formal multidisciplinary DBS work-up, whether further neurological, neuropsychological, imaging or general medical assessment is needed, or whether another treatment direction should be considered first.

The dominant problem may be off-time, dyskinesia, medication-refractory tremor, dystonia, medication side effects, gait, speech, cognition or caregiver burden. The review aims to distinguish potentially realistic procedural goals from symptoms that may not improve with surgery.

For tremor-dominant or otherwise uncertain cases, the consultation can clarify whether a dedicated focused-ultrasound evaluation should be sought. Final MRgFUS candidacy requires assessment by an appropriate treating centre and may require additional imaging and skull-density evaluation.

For selected non-Parkinson movement-disorder cases, the review can clarify whether a DBS-oriented work-up or another advanced treatment pathway appears reasonable, what specialist assessment is still missing and whether referral to an appropriate treating centre should be considered.

For patients who already have DBS, the specialist can review the reported clinical course, programming history, stimulation-related side effects, loss of benefit, battery or hardware concerns and previous revisions, and advise whether further in-person programming, device assessment, replacement or revision should be pursued.

DBS requires repeated programming, neurological monitoring and device follow-up. Any international pathway should also account for medication management, rehabilitation, local clinical support and escalation planning.

No. It is a specialist second opinion that can clarify whether formal DBS assessment appears reasonable and what further work-up may be needed. Final candidacy normally requires multidisciplinary review and may require an in-person neurological examination, formal levodopa challenge, neuropsychological testing, imaging and general medical assessment.

MRgFUS is not the primary focus of this service. For relevant tremor or movement-disorder cases, the review can consider whether a dedicated MRgFUS assessment should be pursued. Final eligibility and treatment must be determined by an appropriate MRgFUS centre.

Selected non-Parkinson movement-disorder cases can be screened when the main question concerns DBS, MRgFUS or another advanced treatment pathway. Suitability depends on the diagnosis, symptoms, available records and the specific decision that needs clarification.

Yes. The remote review can consider programming history, loss of benefit, stimulation side effects, battery or hardware concerns and previous revisions. It does not include device programming or treatment. If in-person programming, replacement, revision or other specialist DBS care is recommended and available, Healwise can coordinate that separately.

Submit the records you already have. Healwise completes a free administrative screening and identifies important gaps before payment and specialist review. A formal levodopa test is helpful, but if it is unavailable, detailed medication-response information can still be submitted for screening.

After the required records, consent and payment are complete, the English-language online consultation is normally offered within one week. Unusually complex files or scheduling constraints may require additional time, which Healwise will communicate before payment.

One short written clarification relating to the same records and clinical question is included for seven calendar days after the written summary is delivered. New records, a new clinical question or another online consultation require a separate scope and fee.

There is no obligation to proceed. If the patient wishes to continue, Healwise can coordinate further diagnostics, multidisciplinary assessment, an in-person appointment, treatment planning and international logistics. The scope and any additional fees are confirmed separately before work begins.

Usually yes. DBS requires long-term programming and device monitoring, while MRgFUS and other advanced therapies require neurological monitoring and may require rehabilitation. Local follow-up capacity should be clarified before treatment abroad is organized.