American Board of Internal Medicine (ABIM) Certification Practice Exam

What action may be necessary for patients experiencing disabling adverse effects from levodopa who have sustained motor benefits?

1. Increasing levodopa dosage

2. Starting physical therapy

3. Deep brain stimulation (DBS) surgery

4. Discontinuing all medications

The correct answer is: Deep brain stimulation (DBS) surgery

For patients who are experiencing disabling adverse effects from levodopa but have sustained motor benefits, deep brain stimulation (DBS) surgery can be a very effective management option. Levodopa is the primary treatment for Parkinson's disease, providing motor benefits and significantly improving quality of life. However, over time, many patients may develop complications, such as motor fluctuations or dyskinesias, leading to adverse effects that can be debilitating. DBS is a neurosurgical procedure that involves implanting electrodes into specific areas of the brain to regulate abnormal impulses. This method has been shown to improve motor symptoms and reduce the complications associated with levodopa treatment, particularly for those who have not found relief through medication adjustments alone. By targeting specific brain regions involved in motor control, DBS can help maintain motor efficiency while minimizing the adverse effects related to medication. In this context, rather than increasing the dosage of levodopa, which might worsen side effects, or discontinuing medications, which would likely lead to a deterioration in motor function, DBS emerges as a viable solution that addresses both the motor benefits and the quality of life challenges presented by the side effects of levodopa treatment. Starting physical therapy may provide some symptomatic relief but does not directly address the underlying motor disturbances