What's on this Page
Clinical fluctuations in Parkinsons Disease
What clinical fluctuations are recognized in Parkinsons Disease?
Although the most dramatic fluctuations in patients with Parkinsons Disease are related to levodopa therapy, some who have not been previously treated with dopaminergic drugs exhibit fluctuations in severity of their symptoms and signs. Fluctuations are not exclusively motor phenomena.
The nonmotor fluctuations (NMF) are classified into three categories: dysautonomic, psychiatric, and sensory. Anxiety, drenching sweat, mental slowing, fatigue, akathesia, and dyspnea are some common NMF described in PD. They may occur during “on” or “off” periods and are associated with higher doses of levodopa.
Significant improvements in such fluctuations have been reported following chronic subthalamic nucleus stimulation.
Mood and autonomic functions also fluctuate. For example, some patients display depression when they are “off” and euphoria when they are “on.” Fatigue and stress usually make these symptoms more prominent.
The most dramatic example of spontaneous fluctuations is paradoxical dyskinesia: under extreme stress, patients completely immobilized by parkinsonism are suddenly able to stand up and run.
Clinical Fluctuations in Parkinsons Disease
| Fluctuation | Management |
|---|---|
| End-of-dose deterioration (“wearing off”) | COMT inhibitors |
| Increase frequency of levodopa doses | |
| Dopamine agonists | |
| Rasalgiline/Selegiline | |
| Amantadine | |
| Infusions of levodopa or dopamine agonists | |
| Delayed onset of response | Give before meals |
| Reduce protein | |
| Infusions of levodopa or dopamine agonists | |
| Drug-resistant “offs” | Increase levodopa dose and frequency |
| Give before meals | |
| Infusions of levodopa or dopamine agonists | |
| Random oscillation (“on-off”) | Dopamine agonists |
| Selegiline | |
| Infusions of levodopa or dopamine agonists | |
| Levodopa withdrawal | |
| Freezing ∗ | Increase dose |
| Dopamine agonists | |
| Atomoxetine |
COMT , Catechol- O -methyltransferase.
∗ May not be related to levodopa therapy.
