American Board of Internal Medicine (ABIM) Certification Practice Exam

Deep brain stimulation is indicated for patients who continue to benefit from dopaminergic medications but have what complications?

1. Sleep disturbances

2. Medication-related complications

3. Bone density loss

4. Weight gain

The correct answer is: Medication-related complications

Deep brain stimulation (DBS) is a neurosurgical intervention aimed at managing motor symptoms in patients with Parkinson's disease who show continued response to dopaminergic medications. However, as the disease progresses, patients may develop complications that can hamper their quality of life and may not be adequately managed with medication alone. Medication-related complications are significant because as the dosage of dopaminergic medications increases to manage symptoms, so too do the side effects that can emerge. These complications can include motor fluctuations, such as dyskinesias (involuntary movements) and wearing-off phenomena, as well as non-motor symptoms like cognitive changes or psychiatric effects, which can significantly affect a patient's daily functioning. In this context, deep brain stimulation becomes a suitable option. It is particularly effective for patients experiencing these medication-related complications, as it can help to reduce or stabilize motor symptoms without relying solely on medications. This reduces the adverse effects associated with higher medication dosages and enhances overall patient management in the long term. Other options, such as sleep disturbances, bone density loss, or weight gain, while they may affect patients with Parkinson's disease, are not primary indications for deep brain stimulation. They may require different approaches to management and do not specifically justify the use of DBS