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.