Managing for the long-term - Strategies for initiating and maintaining successful continuous dopaminergic stimulation treatment

There are many factors that may influence treatment choice in patients with Parkinson's disease. While 'inclusion' criteria include the clinical need for short- and long-term improvement, there are some well defined contraindications to continuous dopaminergic stimulation (CDS) therapies, such as age, cognitive impairment, psychosis or severe orthostatic hypotension. These contraindications vary between CDS therapies and can help guide the choice of treatment. Patient preferences and the practicalities of the treatment modality also play an important part in the decision-making process. Treatment selection algorithms have been developed and presented, but they require refining and need to be expanded to include guidance on management decisions - for example, when initial CDS therapy fails. While more trial data are gathered and as management algorithms evolve, case studies continue to provide important information on practical aspects of CDS therapies.