Deep Brain Stimulation and Medication Management in Parkinson's Disease.

Current medical treatments for Parkinson's disease (PD) are symptomatic, not curative. Over time, patients need additional medications, increased doses, and increased dosing frequencies to control symptoms. Often, medications lose their effectiveness or side effects become intolerable. Deep brain stimulation (DBS) is a surgical option that, unlike other surgical procedures for PD, is externally adjustable and reversible. DBS is best employed in patients whose symptoms have responded to medication, but escalating doses or dosing frequencies are limiting in some way. During the perioperative period, clinicians must manage medication very carefully. Depending on lead placement and the patient's unique symptom constellation, medication changes are likely. Pharmacists who have a good understanding of the procedure can provide exceptional care and counseling.