Both dyskinesia and “off” episodes are common later in the disease course of Parkinson’s. Sometimes patients and their caregivers often have difficulty differentiating between the two states. This article aims to help clarify this differences and discuss available treatment options.

Dyskinesia is an involuntary muscle movement and irregular in motion. Patients may experience writhing or wriggling in their arms or feet, rocking or head bobbing, or swaying. Dyskinesia ranges in severity and may affect only part of the body, such as one leg or arm, or the whole body. Dyskinesia can also affect the mouth and face (lip pursing movements). For some patients it is a minor annoyance. For others it causes embarrassment and may interfere with daily activities such as feeding, dressing, writing, walking, and balance. Dyskinesia usually occurs when the level of levodopa is highest in a patient. A patient may experience kicking leg dyskinesia when their medications start to kick-in and wear-off, but this is very uncommon. Dyskinesia often increases while a patient is anxious or stressed.

Unlike dyskinesia, OFF time refers to when the level of levodopa is lowest in a patient and a PD medications are not working well. For patients, OFF symptoms may include an increase in tremor (rhythmic, regular motion of hands, feet, or jaw), increase in clumsiness or slowness of movement, more shuffling when walking, and muscle cramping or stiffness.

Patients also may experience a number of other non-motor OFF symptoms such as anxiety, depression, apathy, sweating, urinary urgency, or pain. Similar to dyskinesia, OFF episodes range in severity. For some patients, these episodes are a minor annoyance. For others, OFF time can cause embarrassment, interfere with daily activities, or cause walking and balance issues. Like dyskinesia, OFF episodes may be more frequent and more severe when a patient is stressed or anxious.

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Learn About Treatment Options

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