Suite 2, Level 5, 66-80 Pacific Highway,
St Leonards, NSW 2065

Parkinson’s Disease Care

All Neurologists at Integrated Neurology have completed advanced subspecialty training in the diagnosis and management of Parkinson’s disease (PD). This means you’ll receive care from specialists with an in-depth understanding of the condition and the expertise to deliver the latest evidence-based treatments—from diagnosis through every stage of the disease.

We work collaboratively with you and your referring doctor to create an individualised management plan that adapts to your changing needs and supports your quality of life. From oral medications to cutting-edge advanced therapies, you’ll be guided by a team who truly understands the complexity of PD.

Understanding Parkinson’s Disease

Parkinson’s disease is a progressive neurological condition that primarily affects movement but can also impact other important functions in the body. It develops gradually and affects different areas of nervous system function, including:

  • 1. Motor control – movement, coordination, balance, and posture
  • 2. Mood and cognition – emotions, memory, and decision-making
  • 3. Autonomic function – regulation of digestion, bladder, and blood pressure
  • 4. Sleep – initiation and quality of sleep
While there is currently no cure for Parkinson’s disease, effective treatments are available for both motor and non-motor symptoms. With holistic management, most patients with PD are able to experience excellent quality of life for many years after the diagnosis.

Natural History of Parkinson’s Disease

The exact cause of Parkinson’s disease remains unknown. What we do know is that PD is linked to a gradual reduction in dopamine, a neurotransmitter that plays a key role in coordinating movement. This loss of dopamine-producing cells leads to many of the hallmark symptoms of Parkinson’s.

In the early stages of Parkinson’s, medical treatment typically begins with dopamine replacement therapy (DRT) in the form of oral tablets. These medications often provide years of effective relief from motor symptoms like stiffness, slowness, and tremor.

Over time, some people may experience fluctuations in symptom control or develop involuntary movements (dyskinesia). In many cases, adjusting medications can help restore stable symptom relief.

As Parkinson’s advances, oral medications may become less predictable or effective. Patients may experience longer periods of “off” symptoms and more troublesome side effects. When this occurs, it may be time to consider second–line therapies — treatments designed to deliver medication more consistently or to directly influence brain function.

Second-Line Therapy options

Second-line Therapies for Parkinson’s Disease

Second-line or device-assisted therapies can dramatically improve motor control and overall quality of life in people experiencing symptom fluctuations, dyskinesia or medication side effects.

When are second-line therapies generally considered?

Many patients wait until symptoms are severe before exploring second-line therapies, however research suggests earlier intervention leads to better outcomes.

A helpful clinical guideline as to when to consider second-line therapy is the 5-2-1 rule.

  • Taking 5 or more doses of levodopa per day
  • Experiencing 2 or more hours of 'off' time
  • Or having 1 or more hours of troublesome dyskinesia each day

If any of these apply, it may be time to explore more advanced treatment options.

Types of second-line Therapies

1. Apomorphine Infusion

A fast-acting dopamine agonist delivered via:
  • Rescue injections during sudden “off” periods
  • Continuous infusion through a small wearable pump and subcutaneous needle (changed daily)

2. Intestinal Levodopa Infusion (Duodopa)

Delivers levodopa gel directly into the small intestine via a surgically placed tube and portable pump. This method allows for more consistent medication absorption than tablets.

3. Subcutaneous Levodopa Infusion

This treatment involves continuous 24 hour l-dopa delivery under the skin by a wearable pump. Subcutaneous infusions help to improve the problem of variable medication absorption that can occur with oral therapies. Subcutaneous levodopa improves daily on time compared to a regime of oral medication alone.

4. Deep Brain Stimulation (DBS)

A surgical procedure that implants electrodes into specific areas of the brain, connected to a pacemaker-like device. DBS reduces off time, controls dyskinesia, and decreases reliance on oral medications. DBS has been shown to lead to significant improvements in quality of life.

Learn more about DBS

Choosing the Right Therapy

Each second-line therapy has its own benefits and considerations. Your neurologist can help you to weigh up which therapy option is optimal for you. This discussion takes into consideration:

  • Your specific symptom profile
  • Existing health conditions
  • Your personal preferences

At Integrated Neurology, our specialists are highly experienced in all forms of second-line therapy, and work with hospitals to initiate and manage these treatments safely and effectively.

Exercise: A Pillar of Parkinson’s Management

Exercise has been consistently shown to improve motor symptoms and overall wellbeing in people with Parkinson’s disease. Whether it’s walking, dancing, cycling, or resistance training, all forms of exercise (except stretching alone) have been proven beneficial.