Motor Complications- From On-Off fluctuations to dyskinesia.
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.
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.
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.
Dyskinesia or involuntary (unintentional) movements or jerky motions is a side effect of dopaminergic medication and usually occurs after it “peaks” in your system.
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.
Dyskinesia or uncontrolled movements can occur when medications are added or increased.
It is important to keep a diary of your symptoms and tell your doctor if you are experiencing these problems. Throughout the day, record your on times, off times, dyskinesia, and when you take medication.
Author: Monique Giroux, MD