American Board of Internal Medicine (ABIM) Certification Practice Exam

In the long-term management of Parkinson's disease, which treatment may be used for patients resistant to medical therapy?

1. Palliation therapy

2. Electroconvulsive therapy

3. Deep brain stimulation (DBS)

4. Chiropractic adjustments

The correct answer is: Deep brain stimulation (DBS)

Deep brain stimulation (DBS) is an established treatment option for managing Parkinson's disease, particularly for patients who do not respond well to conventional medical therapies or who experience intolerable side effects from medications. DBS involves surgically implanting electrodes into specific areas of the brain, such as the subthalamic nucleus or globus pallidus internus. These electrodes deliver electrical impulses that can help modulate brain activity associated with motor control. The use of DBS can lead to significant improvements in motor symptoms, including tremors, rigidity, and bradykinesia. It has the added benefit of reducing the need for higher doses of dopaminergic medications, which can be associated with long-term complications such as dyskinesias (involuntary movements). Because it directly targets the brain's neural circuits involved in movement, DBS is particularly valuable for patients whose symptoms are not adequately controlled by medications alone. In contrast, palliation therapy focuses on relieving symptoms without curative intent and would not be the preferred approach for addressing the underlying motor issues. Electroconvulsive therapy is not a standard treatment for Parkinson's disease and is primarily used for severe depression. Chiropractic adjustments might provide relief for musculoskeletal issues but do not address the neurological aspects of Parkinson's disease.