PARKINSON’S DISEASE • INTERNATIONAL CASE COORDINATION
Parkinson's Disease Review: DBS vs MRgFUS Candidacy
Prepare an advanced Parkinson’s disease case for movement disorder and functional neurosurgery review when medication fluctuations, dyskinesia, disabling tremor or the choice between DBS, MR-guided focused ultrasound and other therapies remains unresolved.
Initial administrative response is normally within two business days. Clinical review timing depends on documentation and specialist availability.
A focused review for advanced therapy decisions
This pathway is designed for patients with an established or suspected Parkinson’s disease diagnosis whose symptoms are no longer a straightforward medication-management question. Healwise structures the clinical record and coordinates the appropriate specialist review; the receiving licensed team makes all diagnostic and treatment decisions.
DBS review
For selected patients with disabling motor fluctuations, dyskinesia or tremor despite optimized medical therapy. Review usually considers levodopa response, cognition, mood, procedural risk, goals and access to long-term programming.
MRgFUS review
For selected cases in which medication-refractory tremor or another eligible motor complication is the dominant problem. Review must account for the applicable indication, laterality, MRI and skull suitability, gait and balance, cognition and lesioning risk.
Not sure which pathway fits?
You do not need to choose a procedure before submitting the case. A structured specialist review can clarify whether the next step should be medication optimization, rehabilitation, DBS assessment, MRgFUS assessment, infusion therapy or continued local care.
DBS and MRgFUS are different pathways
Neither option is automatically better. The right question is which pathway, if any, matches the diagnosis, dominant symptoms, response to medication, risk profile, goals and follow-up capacity.
Deep brain stimulation (DBS)
- Uses surgically implanted leads and a programmable pulse generator.
- Stimulation can be adjusted over time as symptoms and medication needs change.
- May be considered in selected advanced Parkinson’s disease cases not adequately controlled by best medical therapy.
- Candidacy usually requires diagnostic confidence, assessment of levodopa-responsive symptoms, cognition and mood, general surgical risk and realistic treatment goals.
- Requires access to ongoing programming, medication review, device monitoring and local follow-up.
MR-guided focused ultrasound (MRgFUS)
- Uses MRI guidance and focused ultrasound to create a targeted permanent lesion without implanted hardware.
- It is not programmable or reversible after the lesion has been created.
- Approved indications and treatment scope vary by country, device, target and treating centre.
- Review may include the dominant symptom, laterality, gait and balance, cognition, MRI eligibility, CT-based skull assessment, anticoagulation and general medical risk.
- Long-term neurological and rehabilitation follow-up is still important.
Important: MRgFUS is not simply a non-invasive replacement for DBS. A movement disorder neurologist and functional neurosurgery team must determine whether either pathway is clinically appropriate.
Start with the records you already have
If important documents are missing, Healwise can identify the gaps before the case is sent for specialist review.
Documents usually needed for specialist review
A useful review depends on the symptom pattern over time, the exact medication schedule, response to levodopa, cognition and mood, imaging, daily function and the patient’s priorities.
Core neurology and diagnosis records
- Neurology or movement disorder reports, including the date of diagnosis and diagnostic reasoning.
- Main motor symptoms: tremor, rigidity, slowness, dystonia, freezing, gait difficulty, falls, dyskinesia and wearing-off.
- Non-motor symptoms: cognition, mood, hallucinations, sleep, impulse control, autonomic symptoms, swallowing, speech, pain and fatigue.
- 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.
Medication schedule and levodopa response
- Exact current schedule with drug name, dose, formulation and timing.
- Which symptoms improve after levodopa, how long 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.
- History of apomorphine, levodopa infusion, DBS, MRgFUS or another lesioning procedure, if applicable.
Imaging and advanced therapy work-up
- Brain MRI report and DICOM images where available.
- DaT-SPECT or other nuclear medicine reports if performed.
- Neuropsychological testing, cognitive screening and 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.
- For MRgFUS questions: any previous CT skull-density assessment or focused-ultrasound screening report.
DBS records, if a system is already implanted
- 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.
Function, goals and follow-up capacity
- Physiotherapy, occupational therapy, speech or swallowing assessments and fall-prevention documentation.
- Current independence, caregiver support, work and driving status, nutrition and home-safety concerns.
- Priorities such as reducing off-time, dyskinesia or tremor; improving walking or daily function; or reducing medication burden.
- Available local follow-up: neurologist, movement disorder specialist, DBS programmer, rehabilitation provider and family physician.
How the review pathway works
The process is designed to clarify the next clinical step, not to direct every patient toward a procedure.
What specialists usually assess
Diagnostic confidence and levodopa-responsive symptoms
Specialists review whether the clinical pattern is consistent with Parkinson’s disease, whether there are red flags for atypical parkinsonism, which motor symptoms respond to levodopa and which problems are unlikely to improve with an advanced procedure.
The dominant treatment goal
The main problem may be off-time, dyskinesia, medication-refractory tremor, dystonia, medication side effects, gait or balance, speech, cognition or caregiver burden. A procedure should be considered only when its expected treatment profile matches a clearly defined and realistic goal.
Cognition, mood and general procedure risk
Cognitive function, psychiatric stability, hallucinations, impulse-control problems, cardiovascular and other medical risks, anticoagulation, MRI eligibility, infection risk and caregiver support may all influence whether and how an advanced therapy can be considered.
Follow-up after treatment
DBS requires repeated programming and device follow-up. MRgFUS and other procedures also require neurological monitoring and may require rehabilitation. International treatment should not proceed without a realistic local follow-up and escalation plan.
Other options may still be more appropriate
A high-quality review should compare advanced procedures with reasonable non-procedural and device-assisted alternatives.
Medication optimization
Dose timing, formulations, side effects and non-motor symptoms may need review before any procedural pathway is appropriate.
Infusion therapies
Apomorphine or continuous levodopa delivery may be considered in selected advanced, levodopa-responsive cases, depending on local availability and specialist judgement.
Rehabilitation and support
Physiotherapy, gait and fall prevention, occupational therapy, speech and swallowing support, nutrition and caregiver planning remain central to care.
When local urgent assessment comes first
International case coordination is not emergency care. Seek urgent local medical help for sudden severe worsening, new weakness, collapse, severe confusion, psychosis or suicidal thoughts, swallowing or aspiration risk, dehydration, serious falls, inability to take Parkinson’s medication, or suspected DBS wound, infection, hardware or sudden stimulation problems.
How Healwise supports the pathway
- Organizes reports, medication schedules, symptom diaries and videos, imaging, prior treatments, functional context and patient goals.
- Helps define the review question: diagnostic clarification, DBS assessment, MRgFUS assessment, device or programming review, infusion therapy or rehabilitation planning.
- Coordinates communication among the patient, family, referring physician and receiving specialist team.
- If an in-person pathway is recommended, supports appointments, document transfer, admission and travel preparation, and follow-up handover.
Clinical role boundaries
Healwise does not diagnose Parkinson’s disease, prescribe or adjust medication, determine DBS or MRgFUS eligibility, select a surgical target, program an implanted device or provide treatment.
Diagnosis, candidacy, procedure selection, expected benefit, risk assessment and treatment decisions remain with licensed healthcare professionals and the receiving specialist team.
Frequently asked questions
Does Healwise decide whether I am eligible for DBS or MRgFUS?
No. Healwise prepares and coordinates the case. Eligibility and treatment decisions are made by the receiving movement disorder neurologist, neurosurgeon and other licensed specialists after reviewing the necessary clinical information.
Is MRgFUS a non-invasive alternative to DBS?
It is not a simple substitute. MRgFUS does not require implanted hardware, but it creates a permanent lesion and is not programmable afterwards. DBS uses implanted hardware and requires programming. The suitable pathway depends on the clinical indication, treatment goal, risk profile and follow-up plan.
Can the complete assessment be done remotely?
Records, imaging and the initial clinical question can often be reviewed remotely. Final candidacy may require an in-person neurological examination, levodopa challenge, neuropsychological testing, MRI or CT assessment and evaluation by the treating centre.
What if some records are missing?
Submit the records you already have. Healwise can identify the missing information usually required before a meaningful specialist review is requested.
How quickly will I receive a response?
Healwise normally provides an initial administrative response within two business days. The timing of clinical review depends on document completeness, specialist availability and the receiving provider’s process.
Will I need follow-up in my home country?
Usually yes. DBS requires ongoing programming and device monitoring, while MRgFUS and other advanced therapies require neurological monitoring and may require rehabilitation. Follow-up capacity should be clarified before treatment abroad is organized.
MRgFUS for Tremor
Read more about the focused-ultrasound review pathway for selected tremor cases.
Clinical Pathways
Explore other coordinated specialist pathways for complex international cases.
For Referring Physicians
Submit a structured case or discuss the records needed for specialist review.
Prepare a Parkinson’s disease case for specialist review
Submit the clinical records you already have, or ask which documents are needed for a focused DBS versus MRgFUS review.
