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previews",[218,229,234,246,250,258],{"type":219,"data":220},"video",{"readDurationInSeconds":221,"video":222},242,{"platform":223,"name":224,"url":225,"size":226},"YouTube","Managing Advanced Parkinson's: Motor Fluctuations & Levodopa Strategies","https:\u002F\u002Fyoutu.be\u002FdBJNgZG2V-c",{"width":227,"height":228},200,113,{"type":230,"data":231},"free_text",{"readDurationInSeconds":232,"text":233},16.53333333333333,"\u003Cp dir=\"ltr\">\u003Cspan>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. \u003C\u002Fspan>\u003C\u002Fp>\u003Cp dir=\"ltr\">\u003Cspan>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.\u003C\u002Fspan>\u003C\u002Fp>\u003Cp dir=\"ltr\">\u003Cspan>As patients enter the middle stages of Parkinson’s disease—about 3–5 years after diagnosis—these therapies can become less effective. \u003C\u002Fspan>\u003C\u002Fp>",{"type":235,"data":236},"image",{"readDurationInSeconds":237,"image":238},10,{"alt":239,"title":212,"size":240,"location":243},"Motor fluctuations graph",{"width":241,"height":242},812,438,{"bucket":244,"key":245},"public-drupal-medmastery-assets-production","\u002F2024-01\u002FMotor fluctuations.png",{"type":230,"data":247},{"readDurationInSeconds":248,"text":249},23.466666666666665,"\u003Cp dir=\"ltr\">\u003Cspan>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 \u003C\u002Fspan>\u003Cem>\u003Cspan>OFF-state\u003C\u002Fspan>\u003C\u002Fem>\u003Cspan>, where their symptoms return and are bothersome between medication doses.\u003C\u002Fspan>\u003C\u002Fp>\u003Cp dir=\"ltr\">\u003Cspan>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.\u003C\u002Fspan>\u003C\u002Fp>\u003Cp dir=\"ltr\">\u003Cspan>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.\u003C\u002Fspan>\u003C\u002Fp>",{"type":251,"data":252},"cta",{"readDurationInSeconds":253,"text":254,"buttonText":255,"buttonUrl":256,"teachIllustration":257},4,"Start the first chapter of our Parkinson's Masterclass: Advanced Therapeutics course for free","Start chapter 1 now","https:\u002F\u002Fwww.medmastery.com\u002Fuser\u002Fregister?target=%2Fcourses%2Fparkinsons-masterclass-advanced-therapeutics","https:\u002F\u002Fmedmastery-backend-prod-kjbeds.s3.eu-west-1.amazonaws.com\u002Fmedia\u002Fimages\u002F9ab1a4dc-b2e8-4a53-86a4-1f1d531e4aee",{"type":230,"data":259},{"readDurationInSeconds":260,"text":261},13.333333333333334,"\u003Cp dir=\"ltr\">\u003Cspan>Explore cutting-edge Parkinson’s treatments, including device-assisted and lesioning therapies. 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Elevate your expertise in Parkinson's care today!",{"duration":296,"quizzes":297,"lessons":298},7176,6,36,{"id":300,"name":288,"image":301,"profession":302,"relativeUrl":305,"specializations":306},13652,"https:\u002F\u002Fmedmastery-backend-prod-kjbeds.s3.eu-west-1.amazonaws.com\u002Fmedia\u002Fimages\u002F9c43cf02-eef5-4b9f-95a2-065d9945a2de",{"name":303,"description":304},"Movement Disorder Specialist","Co-director of both the Parkinson’s Disease and Movement Disorders Division as well as the STIM (Surgical Therapies Improving Movement) program at the University of Michigan.","\u002Fteachers\u002Fkelvin-l-chou-md",[270],72,"2m",[310,336,355],{"id":311,"title":312,"text":313,"image":314,"author":321,"path":329,"readDuration":330,"readDurationFormatted":331,"internal":332},1350,"How to Recognize INOCA (ANOCA) on an Exercise Stress Test ","Angina, abnormal stress test, clean coronaries—that's INOCA (or ANOCA), and it carries real risk. 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