Explanation of motor fluctuations in Parkinson's

Let’s explore why patients experience the wearing-off phenomenon as Parkinson's advances.

Kelvin L. Chou, MD
Kelvin L. Chou, MD
26th Jan 2024 • 2m read

In this lesson from our Parkinson’s Masterclass: Advanced Therapeutics, we review the three classic motor signs of Parkinson's disease (PD): bradykinesia, rigidity, and resting tremor. 

First-line therapies for PD include exogenous dopamine replacement with carbidopa-levodopa, or the use of dopamine agonists to mimic dopamine and turn on the dopamine receptor.

As patients enter the middle stages of Parkinson’s disease—about 3–5 years after diagnosis—these therapies can become less effective. 

Drugs like carbidopa-levodopa can wear off more quickly, as well as have a delayed onset, leaving the patient with more time in what has been coined the OFF-state, where their symptoms return and are bothersome between medication doses.

In the advanced stages of Parkinson's, patients may also experience dyskinesias, characterized by head bobbing, swaying in the trunk, and fidgeting in the extremities. These are involuntary movements caused by an excess of dopamine.

Watch this lesson to see examples of bradykinesia and dyskinesia in real-life patients, plus watch the full course for more tips on counseling patients, selecting treatments, and more.

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