Neurology

Beyond the Pill: Advanced Therapies and Your Support Team

At a Glance

For PRKN-related Parkinson disease, deep brain stimulation may help when levodopa causes disabling fluctuations or dyskinesia, but candidacy requires a multidisciplinary assessment. Physical, occupational, speech, mental health support, and tailored exercise remain important for long-term function.

Managing PRKN-related Parkinson’s disease is a long-term commitment. Because this form of the disease typically begins in early adulthood and progresses slowly, your care strategy will evolve over decades. This journey often requires moving beyond standard medications to include advanced therapies and a dedicated team of specialists who understand the unique physical and emotional needs of younger patients ^[1].

Deep Brain Stimulation (DBS)

For many with PRKN-PD, Deep Brain Stimulation (DBS) is a powerful option for managing symptoms when medications alone lead to disabling fluctuations or severe dyskinesia. DBS involves placing tiny electrodes into specific areas of the brain to deliver electrical signals that help regulate movement ^[2].

Because individuals with biallelic PRKN mutations typically have an excellent response to levodopa—a key predictor of DBS success—they are frequently evaluated for this surgery ^[3]^[4]. In some study cohorts of PRKN-PD patients, STN-DBS led to a 43% average improvement in motor scores and a substantial reduction in daily levodopa-equivalent doses ^[5]^[6]. However, these numbers are statistical averages from specific studies, not individual guarantees, and your eligibility depends on a rigorous multidisciplinary evaluation including medication optimization, neuropsychological testing, and psychiatric assessment.

Choosing a Target: STN vs. GPi

Your neurosurgeon and neurologist will help you choose between two primary brain targets. The choice depends on your specific goals and medical profile ^[7]:

Subthalamic Nucleus (STN): Often chosen if your primary goal is to reduce the amount of daily medication you take ^[5]^[8].
Globus Pallidus Internus (GPi): Often preferred if the main problem is severe dyskinesia (involuntary movements) or if there are specific concerns about mood or cognitive vulnerabilities, as GPi-DBS is sometimes considered a possible alternative when these factors are present ^[7]^[9].

Important Considerations: DBS is not a cure, and it does not reliably improve symptoms that fail to respond to levodopa, such as certain gait problems, autonomic issues, or cognitive changes. Surgery carries risks, including bleeding, infection, seizures, and hardware complications. Stimulation itself can sometimes cause side effects like changes in speech, balance, or mood, requiring ongoing programming adjustments and eventual battery replacements.

Building Your Multidisciplinary Care Team

Because PRKN-PD affects more than just your movement, a “team approach” is essential for maintaining your independence and quality of life ^[1]^[10].

Movement Disorders Specialist (MDS): A neurologist with extra training in Parkinson’s. They manage your complex medication schedule and evaluate you for advanced therapies ^[2].
Physical Therapist (PT): Essential for managing the lower-limb dystonia and gait issues common in PRKN-PD. Specialized, safety-screened exercises can improve balance and mobility ^[11]^[12].
Occupational Therapist (OT): Helps you adapt your home and workspace to maintain independence in tasks like dressing, typing, and self-care ^[13]^[14].
Speech-Language Pathologist (SLP): While early cognitive decline is less common in PRKN-PD, some patients experience changes in voice volume or swallowing. Targeted therapy can help maintain clear communication and safe swallowing ^[13]^[15].
Mental Health Professional: Depression and anxiety are common in PRKN-PD. A counselor or psychiatrist is a vital support for your overall well-being ^[16]^[1].

The Role of Consistent Exercise

Regular physical activity and targeted rehabilitation are crucial complements to medication. Studies across Parkinson’s populations show that programs combining education with exercise can improve fitness, balance, strength, and function ^[17]. Whether it is aquatic exercise to ease joint stiffness or resistance training, an individualized activity plan helps you maximize your daily function and quality of life ^[18]^[19]. Always consult a clinician before starting a new intensive program to ensure it accommodates any cardiovascular, orthopedic, or fall risks.

Common questions in this guide

When might someone with PRKN-related Parkinson disease be considered for DBS?

DBS may be considered when Parkinson symptoms remain disabling because levodopa causes major fluctuations or severe dyskinesia. A strong response to levodopa is a favorable sign, but candidacy also depends on medication optimization, neuropsychological testing, psychiatric assessment, and overall health. DBS is not a cure and may not improve symptoms that do not respond to levodopa.

How are the STN and GPi targets chosen for DBS?

The subthalamic nucleus, or STN, is often considered when reducing daily medication is the main goal. The globus pallidus internus, or GPi, may be favored for severe dyskinesia or when mood or cognitive vulnerabilities need special consideration. A neurologist and neurosurgeon choose the target based on your goals and medical profile.

What risks and side effects can DBS cause?

DBS surgery can cause bleeding, infection, seizures, or problems with the implanted hardware. Stimulation may affect speech, balance, or mood and may require programming changes and later battery replacement. Your care team will discuss your individual risks before surgery.

Which specialists can help manage PRKN-related Parkinson disease?

A movement disorders neurologist coordinates medication and advanced therapy evaluation. Physical, occupational, and speech-language therapists can address mobility, daily tasks, communication, and swallowing, while a counselor or psychiatrist can help with depression, anxiety, and emotional well-being. This team approach supports independence over time.

Can exercise help people with PRKN-related Parkinson disease?

Regular, individualized exercise and rehabilitation can improve fitness, balance, strength, and daily function. Aquatic exercise and resistance training are examples that may be adapted to a person's needs. Ask a clinician before starting an intensive program, especially if you have cardiovascular, orthopedic, or fall risks.

What should I ask before pursuing advanced therapy?

Ask whether you are ready for a multidisciplinary DBS evaluation, what your main goal is—fewer pills or less dyskinesia—and whether mood or cognitive issues need attention first. Also ask which therapists can address walking, typing, speaking, swallowing, or other affected activities. This helps align treatment with your daily priorities.

Get notified when new evidence is published on Autosomal recessive juvenile Parkinson disease 2.

We monitor PubMed for new peer-reviewed studies on this topic and email a short summary when something meaningful changes.

References (19)

1
Young Onset Parkinson's Disease: A Modern and Tailored Approach.
Post B, van den Heuvel L, van Prooije T, et al.
Journal of Parkinson's disease 2020; (10(s1)):S29-S36 doi:10.3233/JPD-202135.
PMID: 32651336
2
Collective physician perspectives on non-oral medication approaches for the management of clinically relevant unresolved issues in Parkinson's disease: Consensus from an international survey and discussion program.
Odin P, Ray Chaudhuri K, Slevin JT, et al.
Parkinsonism & related disorders 2015; (21(10)):1133-44.
PMID: 26233582
3
Early cognitive decline after bilateral subthalamic deep brain stimulation in Parkinson's disease patients with GBA mutations.
Mangone G, Bekadar S, Cormier-Dequaire F, et al.
Parkinsonism & related disorders 2020; (76()):56-62 doi:10.1016/j.parkreldis.2020.04.002.
PMID: 32866938
4
Deep brain stimulation surgical timing, outcomes, and prognostic factors in patients with Parkinson's disease: A Chinese retrospective multicenter cohort study.
Wang S, Hu W, Gao Y, et al.
PLoS medicine 2025; (22(8)):e1004670 doi:10.1371/journal.pmed.1004670.
PMID: 40749017
5
Association of Subthalamic Deep Brain Stimulation With Motor, Functional, and Pharmacologic Outcomes in Patients With Monogenic Parkinson Disease: A Systematic Review and Meta-analysis.
Artusi CA, Dwivedi AK, Romagnolo A, et al.
JAMA network open 2019; (2(2)):e187800 doi:10.1001/jamanetworkopen.2018.7800.
PMID: 30707228
6
15-Year Subthalamic Deep Brain Stimulation outcome in a Parkinson's disease patient with Parkin gene mutation: a case report.
Covolo A, Imbalzano G, Artusi CA, et al.
Neurological sciences : official journal of the Italian Neurological Society and of the Italian Society of Clinical Neurophysiology 2023; (44(8)):2939-2942 doi:10.1007/s10072-023-06789-7.
PMID: 37032388
7
Congress of Neurological Surgeons Systematic Review and Evidence-Based Guideline on Subthalamic Nucleus and Globus Pallidus Internus Deep Brain Stimulation for the Treatment of Patients With Parkinson's Disease: Executive Summary.
Rughani A, Schwalb JM, Sidiropoulos C, et al.
Neurosurgery 2018; (82(6)):753-756 doi:10.1093/neuros/nyy037.
PMID: 29538685
8
Long-Term Outcomes of Subthalamic Nucleus and Globus Pallidus Interna Deep Brain Stimulation for Young-Onset Parkinson Disease.
Hey GE, Kamo H, Perez Rodriguez Garcia G, et al.
Neurology. Clinical practice 2026; (16(3)):e200605 doi:10.1212/CPJ.0000000000200605.
PMID: 41908734
9
GPi vs STN deep brain stimulation for Parkinson disease: Three-year follow-up.
Odekerken VJ, Boel JA, Schmand BA, et al.
Neurology 2016; (86(8)):755-61 doi:10.1212/WNL.0000000000002401.
PMID: 26819458
10
Inpatient Enhanced Multidisciplinary Care Effects on the Quality of Life for Parkinson Disease: A Quasi-Randomized Controlled Trial.
Marumoto K, Yokoyama K, Inoue T, et al.
Journal of geriatric psychiatry and neurology 2019; (32(4)):186-194 doi:10.1177/0891988719841721.
PMID: 30966869
11
Tai Chi improves balance, mobility and gait function of the lower limbs in patients with Parkinson's disease: a systematic review and meta-analysis.
Lou L, Xiang C, Hu Y, Yang J
European journal of medical research 2025; (30(1)):107 doi:10.1186/s40001-024-02151-5.
PMID: 39962570
12
Argentine tango in Parkinson disease--a systematic review and meta-analysis.
Lötzke D, Ostermann T, Büssing A
BMC neurology 2015; (15()):226 doi:10.1186/s12883-015-0484-0.
PMID: 26542475
13
An elective two-week interdisciplinary acute rehabilitation program improves functional and speech outcomes in patients with Parkinson's disease.
Markos S, Dibling JP, Petrosyan H, et al.
Frontiers in rehabilitation sciences 2025; (6()):1672759 doi:10.3389/fresc.2025.1672759.
PMID: 41660382
14
[Multidisciplinary Complex Treatment of Parkinson's disease : Cornerstone of an individualized treatment].
Scherbaum R, Tönges L
Der Nervenarzt 2024; (95(8)):704-713 doi:10.1007/s00115-024-01666-w.
PMID: 38755423
15
An Update on Medical and Surgical Treatments of Parkinson's Disease.
Nemade D, Subramanian T, Shivkumar V
Aging and disease 2021; (12(4)):1021-1035 doi:10.14336/AD.2020.1225.
PMID: 34221546
16
Quality of Life in Newly Diagnosed Patients With Parkin-Related Parkinson's Disease.
Zhou XY, Liu FT, Chen C, et al.
Frontiers in neurology 2020; (11()):580910 doi:10.3389/fneur.2020.580910.
PMID: 33391150
17
Functional outcomes of an integrated Parkinson's Disease Wellbeing Program.
Horne JT, Soh D, Cordato DJ, et al.
Australasian journal on ageing 2020; (39(1)):e94-e102 doi:10.1111/ajag.12705.
PMID: 31347232
18
Physical exercise for people with Parkinson's disease: a systematic review and network meta-analysis.
Ernst M, Folkerts AK, Gollan R, et al.
The Cochrane database of systematic reviews 2023; (1()):CD013856 doi:10.1002/14651858.CD013856.pub2.
PMID: 36602886
19
Long-term effects of exercise and physical therapy in people with Parkinson disease.
Mak MK, Wong-Yu IS, Shen X, Chung CL
Nature reviews. Neurology 2017; (13(11)):689-703 doi:10.1038/nrneurol.2017.128.
PMID: 29027544

This page is for informational purposes only and does not constitute medical advice. Your movement-disorders neurologist and multidisciplinary team should determine whether DBS, rehabilitation, or exercise is appropriate for you.