NWPF

Mid Stage Symptoms

PD Stages

Mid stage PD is marked by motor complications. Medications are still effective but no longer control symptoms smoothly throughout the day.  

Motor complications described below are divided into two categories:

  • On-Off flucutations
  • Dyskinesia
Motor Complications- On-Off fluctuations.

Initially, symptoms are smoothly controlled with medication throughout the day. However, movement control with medical treatment can become more difficult as time progresses. These problems first appear as motor fluctuations often referred to as on and off periods.

On - Off periods describe the change in motor control 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.

Dyskinesia or involuntary (unintentional) movements or jerky motions is a side effect of dopaminergic medication and usually occurs after it “peaks” in your system.

The on period is described as the period in which movement is improved or controlled by medicine. The off period is defined as the period that movement or other related problems such as fatigue and anxiety return or are less improved by medication.

End of dose wearing off is the first sign of motor fluctuations, described as a worsening of movement symptoms before the next dose of medication is due. In more advanced stages off periods can occur at other times, especially during times of stress or anxiety.

Treatment of these problems often requires additional doses of medication or the addition of new medications.

Motor Complications- Dyskinesia.
Dyskinesia are a caused by medicines used to treat movement symptoms of Parkinson's disease.  These involuntary movements often accompany on-off fluctuations.

Initially, symptoms are smoothly controlled with medication throughout the day. However, movement control with medical treatment can become more difficult as time progresses. These problems first appear as motor fluctuations or on and off fluctuations as described above. Dyskinesia can emerge as medicine is increased to improve symptoms and/or redcue motor off times.  Factors that increase a person's risk of experiencing dyskinesia include:

  • Younger age
  • Advanced disease
  • Total dose of levodopa
  • Total daily amount of all dopaminergic medicines 
Types of dyskinesia
Peak Dose Dyskinesia
- involuntary movements that occur when levodopa concentration is at  'peak blood levels'.  This typically occurs 30 to 90 minutes after a levodopa dose.
 
Diphasic Dyskinesia - involuntary movements that occurs just after a person takes levodopa or as a wearing effect prior to the next dose.
 
Choreiform dyskinesia - refers to a type of involuntary movement.  Unlike dystonic dyskinesia, these movements are in constant motion such as twitching (not to be confused with tremor), jerking or irregular rhythmic movements of any part of the body. 

Dystonic dyskinesia - refers to the type of involuntary movement.  These movements are defined as a sustained and excessive muscle contraction which leads to twisting (such as the neck or spine), spasm (such as facial spasm) or bending (such as hand, foot or  elbow flexion).
 A motor diary can help you and your doctor tailor medicine doses to time of day that you are having the most trouble. Find these and other helpful forms in My Medical Chart.
  • Record your medicine response and on-off flucutatiuons,  Motor Diary

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