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How can I tell whether medications are wearing off or Parkinson’s disease is progressing?

Tuesday November 27, 2012

How Parkinson’s motor symptoms respond to dopaminergic medication changes over time. Although everyone is different the following stages can help you understand the role of medicines and expectations for their benefit:

Early Stage: Early in the disease,  dopaminergic medications are effective and their effect on movement continues from one dose to the next. This results in a seamless control of motor symptoms and no clear fluctuation in response to each dose. In fact, many people do not notice that their next dose is due and must make the effort to take their medication on the schedule as directed by their healthcare provider. Of course people with Parkinson’s can still have ‘good’ and ‘bad’ days or find that their symptoms change in different situations such as stress, fatigue or illness.   

Mid Stage: Over time, movement control with dopaminergic medical treatment can become more difficult as time progresses. The effects of each medication dose does not last from one dose to the next. However, medication doses continue to improve movement symptoms such as tremor, rigidity and slowed movement. Yet this improvement does not last from one dose to the next requiring medication change - these problems first appear as motor fluctuations often referred to as on and off periods.

  • On – Off periods describe the change throughout the day in response to medication.
  • On is when the medicine improves symptoms
  • Off is when the medicine effect is worn off or is no longer working and symptoms worsen or return. It is first described prior to the next dose of medicine called end of dose wearing off.
  • Dyskinesia or involuntary (unintentional) movements or jerky motions is a side effect of dopaminergic medication and usually occurs after it “peaks” in your system.

Advanced Disease Progression:  Certain symptoms become less responsive to dopaminergic medicines and can increase in severity as the disease progresses. These motor symptoms include balance, freezing of gait, speech and swallowing.  These symptoms do improve with rehabilitation therapy even if they do not improve with medication. It is important to review these problems with your healthcare provider so they can refer you to these specialists.

Talk with your healthcare provider to better understand how your symptoms are responding to medicine.

Rehabilitation therapy includes any of the following
Physical therapy- especially effective for gait, balance and mobility
Occupational therapy- especially helpful for daily activities, chores and hobbies
Speech and Swallowing therapy- focuses on speech and swallowing.

See NWPF's Assemble Your Team page and print a copy of the Comprehensive Care Worksheet posted on NWPF wellncess site for more information on how these therapies can help you

Monique L. Giroux, MDMonique L. Giroux, MD
Medical Director, Northwest Parkinson's Foundation

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