Invasive therapies for Parkinson's disease: an adapted excerpt from the guidelines of the German Society of Neurology

René Reese^#^{1

2}, Thomas Koeglsperger^#^{3

4}, Christoph Schrader⁵, Lars Tönges^{6

7}, Günther Deuschl⁸, Andrea A Kühn⁹, Paul Krack¹⁰, Alfons Schnitzler^{11

12}, Alexander Storch^{13

14

4}, Claudia Trenkwalder^{15

16}, Günter U Höglinger^{3

17

18}; German Parkinson‘s Guideline Group

Affiliations

¹ Department of Neurology, Rostock University Medical Center, Rostock, Germany. Rene.Reese@med.uni-rostock.de.
² Klinik und Poliklinik für Neurologie, Universitätsmedizin Rostock, Gehlsheimer Str. 20, 18147, Rostock, Germany. Rene.Reese@med.uni-rostock.de.
³ Department of Neurology, LMU University Hospital, LMU Munich, Munich, Germany.
⁴ German Center for Neurodegenerative Diseases (DZNE) Rostock/Greifswald, Rostock, Germany.
⁵ Department of Neurology, Hannover Medical School, Hannover, Germany.
⁶ Department of Neurology, St. Josef-Hospital, Ruhr University Bochum, Bochum, Germany.
⁷ Neurodegeneration Research, Protein Research Unit Ruhr (PURE), Ruhr University Bochum, Bochum, Germany.
⁸ Department of Neurology, University Hospital Schleswig-Holstein, Kiel, Germany.
⁹ Movement Disorder and Neuromodulation Unit, Department of Neurology, Charité, University Medicine Berlin, Berlin, Germany.
¹⁰ Movement Disorders Center, Department of Neurology, University Hospital (Inselspital) and University of Bern, Bern, Switzerland.
¹¹ Institute of Clinical Neuroscience and Medical Psychology, Medical Faculty, Heinrich-Heine University, Düsseldorf, Germany.
¹² Department of Neurology, Medical Faculty, Heinrich-Heine University, Düsseldorf, Germany.
¹³ Department of Neurology, Rostock University Medical Center, Rostock, Germany.
¹⁴ Center for Transdisciplinary Neurosciences Rostock (CTNR), Rostock University Medical Center, Rostock, Germany.
¹⁵ Paracelsus-Elena-Klinik, Kassel, Germany.
¹⁶ Department of Neurosurgery, University Medical Center Göttingen, Göttingen, Germany.
¹⁷ German Center for Neurodegenerative Diseases (DZNE), Munich, Germany.
¹⁸ Munich Cluster for Systems Neurology (SyNergy), Munich, Germany.

^# Contributed equally.

PMID: 39985674
PMCID: PMC11846738
DOI: 10.1007/s00415-025-12915-6

Invasive therapies for Parkinson's disease: an adapted excerpt from the guidelines of the German Society of Neurology

René Reese et al. J Neurol. 2025.

. 2025 Feb 22;272(3):219.

doi: 10.1007/s00415-025-12915-6.

Authors

Affiliations

¹ Department of Neurology, Rostock University Medical Center, Rostock, Germany. Rene.Reese@med.uni-rostock.de.
² Klinik und Poliklinik für Neurologie, Universitätsmedizin Rostock, Gehlsheimer Str. 20, 18147, Rostock, Germany. Rene.Reese@med.uni-rostock.de.
³ Department of Neurology, LMU University Hospital, LMU Munich, Munich, Germany.
⁴ German Center for Neurodegenerative Diseases (DZNE) Rostock/Greifswald, Rostock, Germany.
⁵ Department of Neurology, Hannover Medical School, Hannover, Germany.
⁶ Department of Neurology, St. Josef-Hospital, Ruhr University Bochum, Bochum, Germany.
⁷ Neurodegeneration Research, Protein Research Unit Ruhr (PURE), Ruhr University Bochum, Bochum, Germany.
⁸ Department of Neurology, University Hospital Schleswig-Holstein, Kiel, Germany.
⁹ Movement Disorder and Neuromodulation Unit, Department of Neurology, Charité, University Medicine Berlin, Berlin, Germany.
¹⁰ Movement Disorders Center, Department of Neurology, University Hospital (Inselspital) and University of Bern, Bern, Switzerland.
¹¹ Institute of Clinical Neuroscience and Medical Psychology, Medical Faculty, Heinrich-Heine University, Düsseldorf, Germany.
¹² Department of Neurology, Medical Faculty, Heinrich-Heine University, Düsseldorf, Germany.
¹³ Department of Neurology, Rostock University Medical Center, Rostock, Germany.
¹⁴ Center for Transdisciplinary Neurosciences Rostock (CTNR), Rostock University Medical Center, Rostock, Germany.
¹⁵ Paracelsus-Elena-Klinik, Kassel, Germany.
¹⁶ Department of Neurosurgery, University Medical Center Göttingen, Göttingen, Germany.
¹⁷ German Center for Neurodegenerative Diseases (DZNE), Munich, Germany.
¹⁸ Munich Cluster for Systems Neurology (SyNergy), Munich, Germany.

^# Contributed equally.

PMID: 39985674
PMCID: PMC11846738
DOI: 10.1007/s00415-025-12915-6

Abstract

Background: Parkinson's disease (PD) is characterized by hypokinetic motor symptoms, tremor, and various non-motor symptoms with frequent fluctuations of symptoms in advanced disease stages. Invasive therapies, such as deep brain stimulation (DBS), ablative therapies, and continuous subcutaneous or intrajejunal delivery of dopaminergic drugs via pump therapies are available for the management of this complex motor symptomatology and may also impact non-motor symptoms. The recent update of the clinical guideline on PD by the German Neurological Society (Deutsche Gesellschaft für Neurologie e.V.; DGN) offers clear guidance on the indications and applications of these treatment options.

Methods: The guideline committee formulated diagnostic questions for invasive therapies and structured them according to the PICOS framework (Population-Intervention-Comparisons-Outcome-Studies). A systematic literature review was conducted. Questions were addressed using the findings from the literature review and consented by the guideline committee.

Results: Specific recommendations are given regarding (i) the optimal timing for starting invasive therapies, (ii) the application of DBS, (iii) the use of pump therapies in advanced PD, (iv) the indications for ablative procedures, and (iv) selecting the most appropriate therapy according to individual patient characteristics.

Conclusion: This review is an adapted excerpt of the chapters on the use of invasive therapies in PD of the novel German guideline on PD. Clear recommendations on the use of treatment options for advanced PD are provided.

Keywords: Ablation; Deep brain stimulation (DBS); Invasive therapies; Parkinson’s disease; Pump therapy.

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Conflict of interest statement

Declarations. Conflicts of interest: R.R. and T.K. are currently serving as president and vice-president of the German Deep Brain Stimulation Working Group (Arbeitsgemeinschaft Tiefe Hirnstimulation e.V.). R.R. received speaker honoraria from Abbot, Boston Scientifc, Esteve and Medtronic, received travel expenses from Boston Scientific, Esteve and Medtronic and served as a consultant for Boston Scientific outside of this work. T.K. received speaker honoraria and research funding from Abbott, Medtronic and Abbvie. C.S. has received fees from serving on the scientific advisory board for Abbvie in the last 3 years, has received honoraria for speaking at conferences from Abbvie, Bial and Desitin in the last 3 years. L.T. serves as editor for Der Nervenarzt, serves as section editor for Neurological Research and Practice, and serves as editor for Cells, has received fees from serving on the scientific advisory board for Abbvie, Bial, Desitin, Stadapharm, Zambon in the last 3 years, has received fees for speaking at conferences from Abbvie, Bial, Desitin, Stadapharm, Zambon in the last 3 years. G.D. has served as a consultant for Boston Scientific, Cavion and Insightec. He receives royalties from Thieme publishers. He receives funding from the German Research Council (SFB 1261, T1) and private foundations. A.A.K. reports research grants from DFG (German Research Foundation)—Project-ID 424778381– TRR 295 and under Germany´s Excellence Strategy—EXC-2049-390688087, Lundbeck Foundation Grant Nr. R336-2020-1035). She also reports personal fees and travel grants by Medtronic, Boston Scientific and Stadapharm. P.K. reports research or educational grants from Swiss National Science Foundation (FNS 323530_177577/FNS 32003BL_197709-1/FNS 33IC30_198772), ROGER DE SPOELBERCH Foundation, Fondation Louis-Jeantet, Carigest, Institut National de la Santé et de la Recherche Médicale, France Parkinson, Edmond Safra Philantropic Foundation, Bertarelli Foundation, Annemarie Opprecht Foundation, Parkinson Schweiz, Michael J Fox Foundation, Aleva Neurotherapeutics, Boston Scientific, Medtronic, St. Jude Medical, GE Healthcare, Idorsia, UCB, all paid to employing institutions; lecturing fees to employing institution from Boston Scientific, Bial, Advisis; travel expenses to scientific meetings from Boston Scientific, Zambon, Abbvie, Merz Pharma (Schweiz) AG. A.Sch. has received lecture fees from Abbott, Novartis, Kyowa Kirin; has been serving as a consultant for Abbott, Zambon, Medtronic Inc; received royalties from Georg Thieme Verlag; received through his institution funding for his research from the German Research Council, Abbott, and the Brunhilde Moll Foundation. A.S. has received funding from the Deutsche Forschungsgemeinschaft (German Research Association) and the Helmholtz-Association outside the present study. He has received honoraria for presentations/advisory boards/consultations from Global Kinetics Corporation (manufacturer of the PKG®), Esteve, Desitin, Lobsor Pharmaceuticals, STADA, Bial, RG Gesellschaft, Zambon, NovoNordisk and AbbVie outside the present study. He has received royalties from Kohlhammer Verlag and Elsevier Press. He serves as an editorial board member of Stem Cells International. C.T. has received funding from BMBF (ERA Net) BRAVA-Project, and the M.J: Fox Foundation outside the present study. She has received honoraria for presentations/advisory boards and consultations from Abbvie, STADA Pharm, UCB, Roche, Boehringer, Bial, Ono Pharm, Esteve, Convatec. She has received royalties from Thieme publisher and license fees from MAPI for PDSS-2. She serves on the editorial Board of Sleep Med and CNS Drugs, associate editor of NRP. G.U.H. was funded by the Deutsche Forschungsgemeinschaft (DFG, German Research Foundation) under Germany’s Excellence Strategy within the framework of the Munich Cluster for Systems Neurology (EXC 2145 SyNergy—ID 390857198). He has ongoing research collaborations with Roche, UCB, AbbVie; served as a consultant for Abbvie, Alzprotect, Amylyx, Aprinoia, Asceneuron, Bayer, Bial, Biogen, Biohaven, Epidarex, Ferrer, Kyowa Kirin, Lundbeck, Novartis, Retrotope, Roche, Sanofi, Servier, Takeda, Teva, UCB; received honoraria for scientific presentations from AbbVie, Bayer, Bial, Biogen, Bristol Myers Squibb, Esteve, Kyowa Kirin, Pfizer, Roche, Teva, UCB, Zambon; received publication royalties from Academic Press, Kohlhammer, and Thieme. All authors have contributed to, seen and approved the manuscript.

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Invasive therapies for Parkinson's disease: an adapted excerpt from the guidelines of the German Society of Neurology

Affiliations

Invasive therapies for Parkinson's disease: an adapted excerpt from the guidelines of the German Society of Neurology

Authors

Affiliations

Abstract

Conflict of interest statement

References

Publication types

MeSH terms

LinkOut - more resources

Full Text Sources

Medical