Drugs remain, by far, the most common choice, but surgery, particularly pallidotomy and thalamotomy, has become increasingly popular in the past several years. Novel experimental procedures are being studied. Usually, drug therapy will be tried first. Surgical interventions are performed only if the person does not respond to medications or the doctor feels that the quality of life can be improved substantially by non-drug interventions, such as when the symptoms get worse despite trying all available medicines. Today, levodopa therapy remains the gold standard of symptomatic treatment for Parkinson's disease.
Many patients ultimately develop disability due to difficulty with balance and cognition.
For this reason, much research in Parkinson's disease today focuses on how to forestall disability and maintain or improve function over the long-term. New combination druga and surgical procedures available. There is considerable differences of opinion concerning whether the patient should be started immediately on drugs or wait till the disease has progressed. As noted, levodopa loses effectiveness and develops long term complications after 4-5 years. So, the doctors do not want to lose the window of opportunity.