Abstract
Parkinson’s disease (PD) is a progressive neurodegenerative disorder affecting multiple systems and mainly related to dopaminergic deficiency in the substantia nigra resulting in bradykinesia, rigidity and rest tremor. Pharmacological treatments are very successful in the early stages of the disease, but side effects and motor complications are the main problems as the disease reaches to advanced stage. In advanced PD patients, the most disabling complication of long term L-dopa treatment is the unpredictable swings between “on” state with L-dopa induced dyskinesias and “off” state. We will review the current pharmacological and surgical treatment options in advanced stage of PD. The major benefits of deep brain stimulation (DBS) are to smooth motor fluctuations and/or dyskinesia who does not achieve satisfactory symptom control with optimized medical therapy; patients with medically refractory tremor; who are intolerant of dopaminergic drugs; or the patients with a combination of these issues should be considered for DBS surgery. In recent years physical therapy focusing on gait and balance gained more importance.
The advanced PD patients are good candidate for DBS. DBS can improve “on” time, reduce on-off fluctuations, and decrease levodopa-induced dyskinesias but, with the exception of tremor, does not provide motor benefits that exceed the patient’s best “on” medication state and emphasizing the contribution of new perspectives of physical therapies on motor functioning that enhance positive impacts of medical and surgical treatments.

Key words: Parkinson’s disease, L-dopa treatment, Deep brain stimulation (DBS), Physical therapies