Levodopa remains the cornerstone of any long-term Parkinson’s disease treatment plan. However, its ability to control the symptoms of Parkinson’s can become reduced over the years. You may begin to experience what is known as ‘wearing-off’ where your symptoms begin to re-emerge before it is time to take your next scheduled dose.
When experiencing ‘wearing-off’ you may notice changes in your movement and mobility, thoughts and feelings, sensations and your overall sense of well-being.

For example, you may find that your Parkinson’s symptoms begin to re-emerge or become noticeably worse before it is time to take your next scheduled dose of medication. This re-emergence of symptoms is called ‘wearing-off’.

If you are concerned that you might be experiencing “wearing off”, an quick and easy way to find out is by using the wearing-off question card. If you answer one or more of the 19 symptom-related questions with “I experience symptom” and “symptom improves after my next medication dose”, it might be helpful to discuss “wearing-off” with your doctor at your next visit.

What is meant by treatment wearing-off?

Wearing-off refers to the re-emergence or worsening of a Parkinson’s disease symptom, commonly occurring two or more hours after a dose of levodopa medication. These symptoms usually improve or resolve once the next dose of levodopa medication takes effect.

Because Parkinson’s disease is a movement disorder, attention has focused on problems with movement – known as motor symptoms – as these are the cardinal symptoms of Parkinson’s disease and can be easily identified.

Motor symptoms include tremor, rigidity or muscle stiffness and slowness of movement or ‘bradykinesia’.

The tools used by clinicians to identify wearing-off during a clinical assessment mainly focus on the return of these motor symptoms. However, you may experience other symptoms when your medication ‘wears-off’ that aren’t related to movement, and are consequently less obvious. These symptoms of Parkinson’s have been classified as non-motor symptoms.

However, you may experience other symptoms when your medication ‘wears-off’ that aren’t related to movement, and are consequently less obvious. These symptoms of Parkinson’s disease have been classified as non-motor symptoms. Non-motor symptoms can include changes in thoughts and feelings, sensations and sense of well-being and changes in autonomic nervous system functions (e.g. sweating). Although non-motor symptoms may not be as obvious as motor symptoms, they are no less important. On the contrary, non-motor symptoms can actually be more bothersome and disabling than motor symptoms.

Wearing-off can include both motor and non-motor symptoms. Your doctor may not recognize non-motor symptoms of wearing-off as easily as motor symptoms, because they can be quite subjective. Also you may interpret these non-motor symptoms as being part of the normal course of the disease and may not recognize the link to medication doses. You can help your doctor to identify non-motor symptoms by providing a description of how and, importantly, when these symptoms occur, to help your doctor identify these symptoms, as they can be improved if recognized and treated.

TOP