The Fox Focus Fall/Winter 2018 | Page 11

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