Living with Parkinson’s
“Off” involves a person’s usual
symptoms, so these times look
different in each individual.
a mild but increasing tremor
an hour before each dose of
levodopa is due. Still others
may have unpredictable “off ”
episodes of slowness and
stiffness that make it difficult
to move. Many recognize the
movement symptoms (tremor,
slowness, stiffness, walking/
balance problems) that can
occur, but fewer are aware
that “off ” also can bring non-
movement symptoms. Feelings
of anxiety, mental fogginess and
profuse sweating are common.
This variability makes it
difficult not only to interpret
your experiences but also to
relay them to your doctor.
To improve doctor-patient
communication and “off ”
treatment, MJFF-supported
researchers are comparing
how doctors, patients and
care partners talk about these
periods.
TREATING “OFF” TIME
Treating “off ” begins with
looking at how you actually
take your medications (not
just how they’re prescribed).
Taking levodopa doses later
than scheduled or skipping
them can lead to “off.” (Setting
an alarm may help.) Combining
levodopa with meals, especially
high-protein foods, also can
contribute to “off.” If you
take medication on time and
separate from meals, your
doctor may adjust medication
dose or timing (increasing
levodopa to four times a day
from three, for example, if
your symptoms come back
throughout the day) or add
medication.
IMPROVING “OFF”
MEDICATION
apomorphine injection (a drug
that works like dopamine, the
brain chemical that goes missing
in PD) to use as needed. This is
currently the only available on-
demand therapy for “off.” But
two new MJFF-backed therapies,
under U.S. Food and Drug
Administration review at the
time of this writing, may soon
expand options. A reformulation
of apomorphine — an under-
the-tongue dissolvable strip
— and a levodopa inhaler may
offer novel solutions to treat
“off ” as needed, in addition
to scheduled medications. If
approved, these drugs would
provide new routes to rapidly
reverse symptoms, addressing
“off ” more broadly in a
potentially wider population of
people with Parkinson’s.
For unpredictable “off ” times,
doctors also may prescribe an
The medical information contained in this newsletter is for general information purposes only. The Michael J.
Fox Foundation for Parkinson’s Research has a policy of refraining from advocating, endorsing or promoting
any drug therapy, course of treatment, or specific company or institution. It is crucial that care and treatment
decisions related to Parkinson’s disease and any other medical condition be made in consultation with a
physician or other qualified medical professional.
11
Fall/Winter 2018