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Letter to the editor
The Landscape of Parkinson’s Disease Treatment in India: A National Cross-Sectional Survey of Clinical Practitioners -
Roopa Rajan1
, Hrishikesh Kumar2, Divya M. Radhakrishnan1, Divyani Garg1, Shreyashi Jha3, Jacky Ganguly2, Sreenivas U. Meenakshisundaram4, Niraj Kumar5, Vikram V. Holla6, Soaham Desai7, Ravi Yadav6, Achal Kumar Srivastava1, Asha Kishore8, Pramod Kumar Pal6 -
Journal of Movement Disorders 2026;19(2):212-216.
DOI: https://doi.org/10.14802/jmd.25201
Published online: September 11, 2025
1Department of Neurology, All India Institute of Medical Sciences, New Delhi, India
2Department of Neurology, Institute of Neurosciences, Kolkata, India
3University of Western Ontario, London, ON, Canada
4Department of Neurology, MGM Healthcare, Chennai, India
5Department of Neurology, All India Institute of Medical Sciences, Bibinagar, India
6Department of Neurology, National Institute of Mental Health and Neurosciences, Bengaluru, India
7Department of Neurology, Shree Krishna Hospital, Anand, Gujarat, India
8Parkinson and Movement Disorders Centre, Aster Medicity, Kochi, India
- Corresponding author: Pramod Kumar Pal, MD, DNB, DM, FRCP Department of Neurology, National Institute of Mental Health and Neurosciences (NIMHANS), Hosur Road, Bengaluru 560029, Karnataka, India Tel: +91-80-26995417 / Fax: +91-80-26564830 / E-mail: palpramod@hotmail.com
• Received: July 27, 2025 • Revised: September 7, 2025 • Accepted: September 11, 2025
Copyright © 2026 The Korean Movement Disorder Society
This is an Open Access article distributed under the terms of the Creative Commons Attribution Non-Commercial License (http://creativecommons.org/licenses/by-nc/4.0/) which permits unrestricted non-commercial use, distribution, and reproduction in any medium, provided the original work is properly cited.
Dear Editor,
According to the Global Burden of Disease study, 575,946 people were living with Parkinson’s disease (PD) in India in 2016, constituting nearly 9.5% of the global PD population [1]. The relatively high prevalence of early-onset PD (EOPD) in India adds to the socioeconomic burden and calls for focused public health strategies [2]. Prior studies have highlighted several critical challenges in PD care in India, such as suboptimal medication use, polypharmacy, anticholinergic burden, and the use of complementary and alternative medications [3-6]. Studies have also shown low uptake of advanced therapies, such as deep brain stimulation (DBS), due to financial constraints, lack of awareness, and late referrals [7,8]. Despite these insights, significant gaps remain in our understanding of the diversity of PD health care providers, access to allied health professionals, advanced therapies, and the impact of out-of-pocket expenditure on treatment adherence. Most existing evidence is drawn from patient charts or academic hospital-based samples, offering little insight into the perspectives of clinicians managing PD in diverse settings. To address these gaps, we conducted a nationwide cross-sectional survey of clinicians treating PD across India aiming to understand management practices, access to medications and advanced therapies such as DBS, availability of allied health professionals, funding sources, caregiving patterns, and challenges faced by health care providers treating persons living with PD (PwPD). The survey questionnaire, developed by members of the Movement Disorders Society of India–National Parkinson Network (MDSI-NPN), comprised 50 questions covering six domains: clinical diagnosis, treatment availability and resources, funding availability, caregiving and burden of care, practice patterns, and miscellaneous topics. In addition, the survey included seven additional questions regarding participant demography (Supplementary Material 1 in the online-only Data Supplement).
We obtained responses from 267 individual participants, covering 23 (64%) of the Indian states (28) and union territories (8) (Supplementary Figures 1 and 2, Supplementary Tables 1 and 2 in the online-only Data Supplement). The initial diagnosis and follow-up care for PD were provided by various professionals, including neurologists, internists, movement disorder specialists, MBBS doctors, neurosurgeons, and psychiatrists (Figure 1A). According to 82.3% of the respondents, most PwPD consulted a health care provider within 2 years of symptom onset. EOPD (onset <50 years) constituted less than 25% of the PwPD in 83.1% of the practices.
Most respondents (99.6%) reported that PD medications were widely available, but access to advanced therapies, such as surgery (53.2%), apomorphine infusion (21.9%), and intestinal levodopa infusion (2.1%), was limited. Access to multidisciplinary teams, including allied health care professionals, is shown in Figure 1B. Difficult or advanced cases were referred to movement disorder specialists, primarily for surgery or device-based therapies (45.5%), with fewer referrals occurring at diagnosis (6.5%) or when advanced symptoms appeared (30.7%). Overall, 55.4% of participants reported that >75% of the PwPD in their practice paid all expenses out-of-pocket for their treatment needs (Figure 1C). Most physicians (71.0%) reported that the level of awareness regarding PD was low among PwPD and care-partners at the first visit. A total of 71.0% reported no availability of PD support groups in their region. Even if available, 61.2% felt that only <25% of the PwPD accessed these facilities. Most respondents reported rarely advising individuals newly diagnosed with PD to undergo computed tomography scans (75.7%), dopamine transporter single-photon emission computed tomography (94.4%), or genetic testing (94.9%), while 71.5% frequently recommended magnetic resonance imaging. Trihexyphenidyl (96.1%) and pramipexole (95.2%) were the most widely available drugs, along with both immediate and controlled-release levodopa preparations (92.2% and 93.5%, respectively). The availability of other medications is shown in Figure 1D, Supplementary Tables 3 and 4 (in the online-only Data Supplement). DBS was locally available to 68.8% of the practices, whereas RF ablation and magnetic resonance–guided focused ultrasound were available in 17.7% and 10.0%, respectively. Despite counseling, DBS acceptance remained low (<50%) in 81.4% of the practices. Telemedicine was offered by 52.8% of the respondents, but usage by PwPD was low, with 88.5% reporting less than 25% uptake. Advanced care planning or palliative services were unavailable in 70.1% of the practices. Although 74.0% of the respondents were aware of PD treatment guidelines, 93.9% felt a need for India-specific recommendations (Supplementary Material 2 in the online-only Data Supplement).
This national clinician survey highlights significant gaps in the diagnosis, treatment, and multidisciplinary care of PD across India. In contrast to those in previous studies, more than one-third of our study participants were from private specialty or tertiary care institutions, covering an important demographic, given the growing role of the private sector in Indian health care services. Furthermore, we collected responses from most (64%) territories of India, except Chhattisgarh and the northeastern states (excluding Assam). Although the survey was broadly representative, 92.1% of the respondents practiced in urban areas, reflecting India’s significant urban–rural doctor density gap (3.8:1), which is even more pronounced for specialists such as neurologists and internists. A 2015 analysis of 3,666 professional society members revealed that no neurologist or neurosurgeon resided in regions covering 934.8 million people; approximately 30% lived in major metropolitan cities, 30% in state capitals, 30% in Tier 2 cities, 7% in Tier 3 cities, and just 3% in rural areas serving 84.59 million people [9]. Delivering PD care in the context of this imbalance will require empowering nonspecialist providers, improving referral systems, and expanding outreach and telemedicine services. Most practices lacked several key members of the recommended core team for multidisciplinary care, such as movement disorder neurologists, PD nurses, dieticians, occupational therapists, speech therapists, physiotherapists, psychiatrists/neuropsychologists, and social workers. Given the limited number of specialists, developing and implementing the role of PD nurse specialists may expand care access for PwPD in India. PD medications were widely available, with anticholinergics, pramipexole, and controlled-release levodopa reported at more locations than immediate-release levodopa. Similar findings were reported from other countries in the South Asian/Southeast Asian region; however, due to the glaring diversities in health care systems, differences in socioeconomic status, and differences in survey instruments, meaningful regional comparisons were difficult. Our findings highlight the urgent need for region-specific guidelines, improved access to advanced therapies, and enhanced education and support systems for both clinicians and PwPD. They also underscore the importance of establishing a nationwide network involving health care professionals, PwPD, care partners, and policymakers to bridge identified care gaps.
Supplementary Materials
The online-only Data Supplement is available with this article at https://doi.org/10.14802/jmd.25201.
Supplementary Table 1.
Demographic characteristics of responders
Supplementary Table 2.
Participant representation from individual states and territories
Supplementary Table 3.
Number of respondents reporting availability of each medication
Supplementary Table 4.
Medications preferred for initial therapy by respondents
Supplementary Figure 1.
Distribution of survey responders across the country.
Supplementary Figure 2.
Proximity to location of clinical practice. A total of 52.8% of physicians reported that majority (>50%) of the PwPD visiting them were from within their city/district. In contrast, 22.9% of physicians reported that <25% of PwPD in their practice were from their district. Moreover, 73.6% reported that less than one-fourth of the PwPD were from outside their state. PwPD from out of the country accounted for a minority of the PwPD seen by 95.2% of physicians. PwPD, persons living with Parkinson’s disease.
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Ethics Statement
This study was approved with waiver of written informed consent by the Institute Ethics Committee at the All India Institute of Medical Sciences, New Delhi (Reference No: AIIMSA2122/06.09.2024). A brief description of the survey goals was provided, and online consent was obtained prior to participation.
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Conflicts of Interest
The authors have no financial conflicts of interest.
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Funding Statement
None
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Acknowledgments
None
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Author Contributions
Conceptualization: Pramod K. Pal, Roopa Rajan, Hrishikesh Kumar. Data curation: Roopa Rajan, Hrishikesh Kumar. Formal analysis: Roopa Rajan, Pramod Kumar Pal. Investigation: all authors. Methodology: all authors. Project administration: Roopa Rajan, Pramod Kumar Pal. Resources: Pramod Kumar Pal, Hrishikesh Kumar. Software: Roopa Rajan. Supervision: Pramod Kumar Pal. Validation: Vikram V. Holla, Soaham Desai, Ravi Yadav, Achal Kumar Srivastava, Asha Kishore, Pramod Kumar Pal. Visualization: Roopa Rajan. Writing—original draft: Roopa Rajan. Writing—review & editing: Hrishikesh Kumar, Divya M. Radhakrishnan, Divyani Garg, Shreyashi Jha, Jacky Ganguly, Sreenivas U. Meenakshisundaram, Niraj Kumar, Vikram V. Holla, Soaham Desai, Ravi Yadav, Achal Kumar Srivastava, Asha Kishore, Pramod Kumar Pal.
Notes
Figure 1.
Care professionals, funding, and medications for treatment of PD. A: Availability of healthcare professionals. Principal care professional for diagnosis: 80.1% reported that the initial diagnosis of PD in their practice setting was usually made by a neurologist; 54.1% reported that the initial diagnosis was made by internist equivalent doctors. Movement disorder specialists made the initial diagnosis according to 12.6% participants and MBBS doctors according to 7.8%. Principal care professional for follow-up: 85.7% reported that in their locality, persons living with PD are usually taken care of by a neurologist. Other healthcare providers assuming this primary role included internist equivalent doctors (48.9%), movement disorder specialists (19.5%), neurosurgeons (12.6%), psychiatrists (7.8%), and MBBS doctors (7.4%). B: Availability of multidisciplinary team: important roles that could rarely be accessed locally included PD nurse (94.4%), movement disorder specialist (79.2%), speech therapist (59.3%), swallowing specialist (71.5%), neurosurgeon with DBS expertise (84.4%), and psychologist (58.9%). On the other hand, neurologists (75.4%), physiotherapists (73.6%), and psychiatrists (65.4%) were frequently accessible. PD, Parkinson’s disease; DBS, deep brain stimulation. Care professionals, funding, and medications for treatment of PD. C: Sources of funding for out-patient treatment, hospital admissions, and surgical treatments for PwPD, showing proportion of practices (x-axis) where the funding modalities (y-axis) are available. D: Availability of medications commonly used to treat PD. PwPD, persons living with PD; PD, Parkinson’s disease; DBS, deep brain stimulation; CR, controlled release; IR, immediate release; ER: extended release; NGO, non-governmental organization.
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Figure 1. Care professionals, funding, and medications for treatment of PD. A: Availability of healthcare professionals. Principal care professional for diagnosis: 80.1% reported that the initial diagnosis of PD in their practice setting was usually made by a neurologist; 54.1% reported that the initial diagnosis was made by internist equivalent doctors. Movement disorder specialists made the initial diagnosis according to 12.6% participants and MBBS doctors according to 7.8%. Principal care professional for follow-up: 85.7% reported that in their locality, persons living with PD are usually taken care of by a neurologist. Other healthcare providers assuming this primary role included internist equivalent doctors (48.9%), movement disorder specialists (19.5%), neurosurgeons (12.6%), psychiatrists (7.8%), and MBBS doctors (7.4%). B: Availability of multidisciplinary team: important roles that could rarely be accessed locally included PD nurse (94.4%), movement disorder specialist (79.2%), speech therapist (59.3%), swallowing specialist (71.5%), neurosurgeon with DBS expertise (84.4%), and psychologist (58.9%). On the other hand, neurologists (75.4%), physiotherapists (73.6%), and psychiatrists (65.4%) were frequently accessible. PD, Parkinson’s disease; DBS, deep brain stimulation. Care professionals, funding, and medications for treatment of PD. C: Sources of funding for out-patient treatment, hospital admissions, and surgical treatments for PwPD, showing proportion of practices (x-axis) where the funding modalities (y-axis) are available. D: Availability of medications commonly used to treat PD. PwPD, persons living with PD; PD, Parkinson’s disease; DBS, deep brain stimulation; CR, controlled release; IR, immediate release; ER: extended release; NGO, non-governmental organization.
Figure 1.
The Landscape of Parkinson’s Disease Treatment in India: A National Cross-Sectional Survey of Clinical Practitioners
