Device assisted therapies

Device-assisted therapies (DAT) can give you relief from advanced Parkison’s symptoms.

From brain surgery to pumps, a DAT can help improve your wellbeing when optimised oral or patch medications no longer seem to be doing the job.

What are Device-Assisted Therapies?

Device-Assisted Therapies (DAT) are advanced treatments used when oral or patch medications no longer control Parkinson’s symptoms well. They deliver medication continuously or use brain stimulation to reduce motor fluctuations and improve quality of life.

Main Types of DAT

Therapy	How it works	Pros	Cons / Risks
Apomorphine infusion	A small pump delivers apomorphine under the skin.	Less invasive, reversible, reduces “OFF” time.	Skin reactions, nausea, low blood pressure.
Levodopa intestinal gel (Duodopa/Lecigon)	Medication pumped directly into the small intestine via a surgically placed tube.	Provides steady levodopa levels, reduces fluctuations.	Requires surgery, risk of infection, tube problems.
Levodopa subcutaneous infusion (Vyalev, ABBV-951, ND0612 – emerging)	Continuous infusion under the skin (like an insulin pump).	VYALEV is n the PBS, avoids surgery, can replace oral levodopa.	Skin site issues.
Deep Brain Stimulation (DBS)	Electrodes implanted in the brain deliver electrical pulses.	Strong evidence for reducing tremor and dyskinesia, less daily management.	Requires brain surgery, risk of bleeding, infection, mood or cognitive changes.

Sources: australianprescriber.tg.org.au link.springer.com

Who might benefit?

People with advanced Parkinson’s who have disabling motor fluctuations or dyskinesias despite optimised oral therapy.
Those needing levodopa 4+ times daily, or experiencing ≥2 hours of OFF time or ≥1 hour of troublesome dyskinesia per day (known as the “5-2-1 criteria”).
Patients with severe tremor not controlled by medication.

Access and decision-making

DAT should be considered in specialist movement disorder clinics with a multidisciplinary team.
Choice depends on age, health conditions, lifestyle, support at home, and patient preference.
Worldwide, access is uneven. Some patients face delays due to referral patterns, clinician biases, or health system barriers.

Benefits

Reduced “OFF” time and improved mobility.
Better quality of life and independence.
Potential reduction in oral medication burden.

Challenges

Invasiveness: DBS and intestinal gel require surgery.
Complications: Device problems, infections, or side effects.
Support needs: Pumps often require daily help from caregivers.
Access disparities: Women, minorities, and rural patients may be less likely to be referred for DAT.

Device-Assisted Therapies are not cures, but they can transform life with advanced Parkinson’s by smoothing out symptoms when tablets no longer work well. Decisions should be made together with specialists, considering risks, benefits, and personal preferences.

Thinking about Device-Assisted Therapies (DAT): when to seek help

As Parkinson’s progresses, tablets and patches may not control your symptoms as well as they once did. This is often the point where people and their carers should start asking about Device-Assisted Therapies (DAT). DAT is not just about “advanced” or “end-stage” Parkinson’s, it can be considered earlier if symptoms are interfering with things you want to do in your daily life.

Signs it may be time to explore DAT

Frequent OFF periods: If you spend more than two hours a day in “OFF” time (when medication isn’t working and symptoms return), it’s worth discussing DAT.
Troublesome dyskinesias: Involuntary movements that last more than an hour a day despite medication adjustments.
Complex medication schedules: Needing levodopa four or more times daily, or juggling multiple drugs without stable relief.
Uncontrolled tremor: Severe tremor that doesn’t respond to oral therapy.
Impact on daily life: When symptoms limit independence, social activities, or sleep, despite following treatment plans.

Why questioning your therapy matters

Many people live with bothersom symptoms longer than they need to because they assume nothing more can be done. Asking your neurologist or Parkinson’s nurse about DAT can open up new options. Carers and your care team also play a key role here, tracking symptoms, noticing changes, and raising concerns during appointments.

Practical steps for patients and carers

Track symptoms daily: Note OFF times, dyskinesias, sleep quality, and medication effects.
Bring records to appointments: Reports from allied health professionals for your neurologist, or a simple diary or app can help your care team see patterns.
Ask direct questions: “Am I a candidate for DAT?” or “What options exist beyond continuing to increase my tablets?”
Seek specialist input: Movement disorder clinics are best placed to assess eligibility.

The bigger picture

DAT is not a cure, but it can smooth out symptoms and improve your quality of life.

Key Statistics

Deep Brain Stimulation (DBS) reduces motor symptoms by ~50%
Levodopa-Carbidopa Intestinal Gel (LCIG) reduces OFF time by 4–6 hours per day
Apomorphine infusion doubles “good ON” time
DAT improves health-related quality of life (HRQoL) significantly

How do I access DAT?

It’s advisable to explore all available pathways to find the support that best suits your individual needs. Look to:

getting a neurologist assessment and referral to someone with Parkinson‘s DAT experience
your state-based Parkinson’s organisation for advice on local services to access
private health to see what is covered in relation to consultations and expenses
DVA, NDIS or My Aged Care plan supports.

Infosheet under review

References

Antonini, A., Chaudhuri, K. R., & Odin, P. (2022). Levodopa–carbidopa intestinal gel in advanced Parkinson’s disease: Long-term outcomes. Pharmaceutics, 14(6), 1115. https://doi.org/10.3390/pharmaceutics14061115
Deuschl, G., Schüpbach, M., & Timmermann, L. (2023). Deep brain stimulation for Parkinson’s disease: A systematic review and meta-analysis. BMJ Medicine, 3(1), e000705. https://doi.org/10.1136/bmjmed-2022-000705
Dijk, J. M., Espay, A. J., Katzenschlager, R., & de Bie, R. M. A. (2020). The Choice Between Advanced Therapies for Parkinson’s Disease Patients: Why, What, and When?. Journal of Parkinson’s disease, 10(s1), S65–S73. https://doi.org/10.3233/JPD-202104
Martinez-Martin, P., Rizos, A., & Antonini, A. (2023). Continuous subcutaneous apomorphine infusion in Parkinson’s disease: A review of real-world evidence. Frontiers in Neurology, 14, 10525070. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC10525070/
Mouchaileh, N., & Cameron, J. (2025). Device-assisted therapies for Parkinson disease. Australian prescriber, 48(1), 10–17. https://doi.org/10.18773/austprescr.003
Odin, P., Ray Chaudhuri, K., & Antonini, A. (2025). Device-aided therapies and quality of life in advanced Parkinson’s disease: A multicenter study. Journal of Neural Transmission, 132(2), 123–134. https://doi.org/10.1007/s00702-025-03066-z