Education

♦ The results of the 'on'/'off evaluation should be discussed in detail with the patient.

♦ Only 'motor' symptoms responding to medications are likely to respond to surgery (use the 'on'/'off' evaluation as the guide to discussion).

♦ If the patient's gait/balance when optimized on their medication and in their best 'on' does not improve, then surgery will probably not help that symptom.

♦ Nonmotor symptoms like depression, anxiety, and quality of life may improve, worsen, or stay the same, but at this time there are no reliable predictors to discuss with patients.

♦ It may be useful (both before and after surgery) to have patients study and discuss with their clinican a mnemonic device that may help with perceived outcomes (103).

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