Fast Five Quiz: Management of Parkinson's Disease

Rajesh Pahwa, MD


January 13, 2022

After taking levodopa therapy for multiple years, many patients experience motor fluctuations. These typically arise as a decline in motor symptoms before a patient's next dose of medication, creating a "wearing-off" phenomenon. The time when medication is providing benefit for bradykinesia, rigidity, and tremor is referred to as "on" time, whereas the time when medication is not providing benefit is called "off" time. As the disease continues to progress, dyskinesias may occur throughout the dosing cycle, during wearing-off periods (diphasic dyskinesias) and also at peak dose periods (peak-dose dyskinesias). Therefore, the objective of pharmacologic management is to minimize medication off time and time on with troublesome dyskinesia.

Preliminary observational data suggest that long-acting and transdermal formulations of dopamine agonists are associated with lower rates of impulse control disorders than are short-acting formulations.

It appears that no single formulation of dopamine agonist is superior.

Learn more about therapy for symptoms of advanced disease.


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