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Dr. Okun

Is three times a day dosing enough to qualify for PD DBS?

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I am a 75 year old male diagnosed PDE 1994 currently taking senemet CR three

times a day along with Mira packs 1 mg three times a day. Supplementing

this their siege with 25/100 senemet when needed. I'm experiencing the typical

PD symptoms such as freezing balance problems various pains in various places

especially in the mornings which I attribute to stiffness. People tell me

I'm doing well considering the length of time I've had this disease. I don't

feel that I'm doing that well because the disease is progressing and my ON

times are decreasing as the OFF times are increasing. Some days it seems that

I'm spending the whole day in some degree of discomfort and general slowness

of motions.


I have a neurologist that has been watching me for about one year and he

recently said that I'm a candidate for DBS. I saw a neurosurgeon twice in this

past year and like an automobile going to a mechanic for repairs I I did not

show much of the symptoms. Consequently, the neurosurgeon is not impressed

by my symptoms and states that I may be disappointed because the results may

not be as dramatic as I may expect. The neurosurgeon also states that the

greatest effect of this DBS is in tremors of the hands and arms. I have minor

tremors in my hands and arms. My difficulty is in pain and stiffness slow

motions balance etc. which seem to be connected to the body rather than the



What is your opinion of this -- please thank you very much

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Be careful. Taking medications three times a day is not appropriate for a medication trial in a potential DBS patient. You need more intervals and more combinations of meds. Only symptoms that respond to meds will respond to surgery and you need medication optimization as a first step.


Next you need a full multidisciplinary team and an on/off UPDRS after optimization. DBS is complex and you may or may not be a candidate,


Be cautious.


Go to www.parkinson.org and download the free book on DBS and look particularly at expectations.

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