For many people living with Parkinson’s, medications are an effective way to manage symptoms, especially in the earlier stages of the condition. Over time, however, some people notice that their symptoms become harder to control or that the benefits of medication are less predictable.

As Parkinson’s progresses, the brain gradually loses its ability to store and release dopamine efficiently. This can shorten the amount of time each dose provides effective symptom control – when medication is working well and symptoms are managed without bothersome side effects – and lead to more noticeable “off” periods, medication fluctuations, or side effects such as dyskinesias. When symptoms begin to interfere with daily activities or quality of life despite careful medication adjustments, conversations about advanced therapies may begin.

Advanced therapies are not a last resort. Instead, they represent a different approach to managing symptoms when oral medications alone are no longer providing consistent control.

When are advanced therapies considered?

Advanced therapies may be considered when Parkinson’s symptoms are no longer adequately controlled with optimized oral medications. This can include:

  • Increased “off” periods (times when medication is not working well and symptoms return)
  • Dyskinesias (involuntary movements related to long-term levodopa use)
  • Fluctuations in how well or how long medication works
  • Side effects that limit further medication adjustments


Eligibility for advanced therapies is not based on how long you have had Parkinson’s, but rather on how your symptoms are responding to treatment.

What are advanced therapies?

Advanced therapies aim to provide more consistent symptom control. Some do this by delivering medication continuously, helping reduce the peaks and valleys that can occur when pills are taken several times a day. Others work by directly influencing brain circuits involved in movement rather than increasing dopamine levels.

The main approaches include:

  • Deep brain stimulation (DBS)
  • Continuous medication delivery (infusion therapies)
  • Focused ultrasound (in select cases)


These treatments are typically offered through specialized centres with expertise in Parkinson’s care.

Deep brain stimulation (DBS)

Deep brain stimulation (DBS) is a surgical treatment that involves implanting thin electrodes into specific areas of the brain. These electrodes are connected to a small device (similar to a pacemaker) placed under the skin in the chest, which sends electrical signals to help regulate abnormal brain activity associated with Parkinson’s.

DBS may help:

  • Reduce motor symptoms such as tremor, stiffness, and slowness
  • Decrease “off” time
  • Reduce dyskinesias
  • Allow for lower doses of some medications in certain cases


DBS does not cure Parkinson’s or stop its progression. Unlike medications, DBS does not add dopamine. Instead, it helps to normalize activity in brain circuits involved in movement. Because stimulation settings can be adjusted over time, DBS can be tailored as symptoms change. It is most effective for symptoms that respond to levodopa.

Continuous medication delivery (infusion therapies)

Infusion therapies deliver Parkinson’s medication continuously using a pump system, helping maintain more stable medication levels than oral dosing. By providing medication at a steady rate, infusion therapies can help reduce the ups and downs associated with oral dosing. This more consistent delivery may improve “on” time, reduce “off” periods, and lessen dyskinesias that occur when medication levels rise and fall sharply. These therapies are generally considered when symptom fluctuations become difficult to manage despite careful medication adjustments.

Two main approaches are used:

  • Intestinal gel infusion delivers a levodopa-carbidopa gel directly into the small intestine through a tube surgically inserted into the abdomen. By bypassing the stomach, it can improve the consistency of medication absorption.
  • Subcutaneous infusion delivers medication under the skin through a small wearable pump.


Like DBS, infusion therapies require ongoing management and are not suitable for everyone.

Focused ultrasound (FUS)

Focused ultrasound (FUS) uses targeted ultrasound energy to create a small lesion in a specific area of the brain involved in movement. The procedure does not involve an incision. Unlike DBS, FUS is not adjustable or reversible and does not involve implanted hardware.

FUS is only suitable for some people with Parkinson’s, and eligibility is assessed by a specialized, multi-disciplinary team through a movement disorder clinic.

Matching therapies to symptoms

There is no single “best” advanced therapy. Choosing an option depends on the symptoms that most affect daily life. Some therapies are particularly helpful for motor fluctuations and dyskinesias, while others may be considered for medication-resistant tremor. Certain symptoms, such as balance problems or freezing of gait, may be less responsive to current advanced treatments.

Referral and decisionmaking in Canada

Access to advanced therapies in Canada typically begins with a referral to a neurologist or movement disorder specialist. If appropriate, you may then be referred to a specialized centre for further assessment.

The assessment process often includes:

  • A review of your medical history and current symptoms
  • An evaluation of your response to medication
  • Cognitive or mental health assessments
  • Imaging or other tests, depending on the therapy


Decision making is shared between you, your care partner (if applicable), and your health care team. Your lifestyle, preferences, and the potential benefits and risks of each therapy all play an important role.

Availability across provinces

Access to advanced Parkinson’s therapies varies across Canada:

  • DBS is available in several provinces, typically through specialized centres
  • Infusion therapies may be available depending on provincial funding and clinic capacity
  • Focused ultrasound is more limited and offered only at select sites


Your care team can help you understand what options are available where you live.

Taking the next step

If you think your current treatment is no longer meeting your needs, consider speaking with your health care provider about whether advanced therapies may be an option.

Learning about your choices and asking questions can help you make informed decisions that could help improve your symptom control and quality of life. Understanding your options—and asking the right questions—can help you make informed decisions that reflect your goals and priorities.

Looking to learn more? Visit our Treatments and Therapies page for additional information and resources.

Connect with Parkinson Canada. Our Support & Information team is here to help you navigate your journey with Parkinson’s and get connected with the right support and programs to meet your needs.