Although both dyskinesia and OFF episodes are common aspects of living with Parkinson’s disease and become more prevalent later in the disease course. Levodopa-induced dyskinesia often involves involuntary muscle movements such as twitches, jerks, twisting and writhing. While “OFF” time occurs when Levodopa is wearing off and the patient has less control of their movements. These are referred to motor fluctuations.
While differentiating between dyskinesia and OFF episodes can be challenging, this article aims to highlight the distinguishing factors of each and discuss the different methods in which they can be managed.
Dyskinesia
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.
OFF Time
“OFF” time refers to when Parkinson’s medications are not working well and there is an increase in troublesome symptoms such as: tremor, increased clumsiness, slowness of movement, shuffling when walking, and muscle cramping/stiffness.
Dyskinesia is an involuntary muscle movement that is irregular in motion. Patients may experience writhing or wriggling of 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 level in the bloodstream and dopamine levels are also at the highest (sometimes referred to as “Peak dose”). 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. Typical treatment for dyskinesia involves the use of amantadine products, as well as reduction of Levodopa dosing, and invasive therapies. Read more below.
Unlike dyskinesia, OFF episodes occur when the level of levodopa is lowest in a patient and a patient’s medications are not working well. This is also known as “Wearing Off”. These episodes become more common after taking Levodopa for a longer time as the disease progresses. For patients, OFF symptoms may include an increase in tremor (rhythmic, regular motion of hands, feet, or jaw), an increase in clumsiness or slowness of movement, more shuffling when walking, and muscle cramping or stiffness. Patients also may experience several 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.
While off episodes are a typical part of the PD progression, there are options available to help manage or reduce these episodes, such as: adjusting dosage or time of day, changing the type of Carbidopa/Levodopa, implementing an amantadine product, device aided therapies, and diet considerations. Read more below.
Read more about additional treatment options
Reduction of Levodopa Therapy for Dyskinesia
With ongoing Levodopa therapy for months or more commonly, a few years of treatment, two major types of motor complications tend to arise: motor fluctuations and dyskinesias. Motor fluctuations are variations in mobility associated [...]
Amantadine Products
Amantadine is also an older medication that was initially developed to help prevent influenza Type A. It was subsequently found to have a mild but definite effect on Parkinson’s without worsening typical symptoms. More [...]
Invasive Therapies
Fortunately, there are more advanced options to consider if medical therapies do not seem to alleviate the symptoms of dyskinesia: Deep Brain Stimulation (DBS) Deep brain stimulation (DBS) should be considered for patients who [...]