Managing Parkinson's 'Wearing-Off' Symptoms - Part II

Susan J. Mayor, BSc, MSc, PhD
September 24, 2004

"How Can I Manage This Problem?"

This is the second of two articles. To read the first one "Early Diagnosis and Optimized Treatment are Key", click here .

Identifying wearing-off early

If you think you are starting to have wearing-off, you should see your PD doctor to discuss the problem. Letting your doctor know about your wearing-off early can have several benefits. Your treatment can be optimized to reduce your symptoms. Wearing-off can be an early warning sign of another problem with long-term levodopa therapy - unwanted, uncontrolled movements (called dyskinesias). "It is possible that wearing off leads to the development of dyskinesia. If that is the case, treating wearing off early could reduce the risk of dyskinesias, although this remains to be proven," explained Professor Hauser.

Don't wait for your doctor to ask about wearing-off - tell him or her how long your treatment is lasting for, and what happens when it wears off. Doctors treating PD tend to focus on motor symptoms so they may not ask you about non-motor symptoms, such as anxiety or fatigue, which can occur in wearing-off.

It will help your doctor to understand what is going on if you give as much information as possible. One way to do this is to keep a diary for a few days, noting what time you take your levodopa or other PD medication, what time you start to suffer from wearing-off symptoms, and what these symptoms are.

An easy way to identify wearing-off yourself is by using the wearing-off question card. If you can answer one or more of the 19 questions with "I experience symptom" and "symptom improves after my next medication dose", you may want to talk to your doctor about your wearing-off at next visit.

Wearing-off question card

The wearing-off question card has been developed together with Parkinson's disease specialists, patients and the European Parkinson's Disease Association. The wearing-off question card can be downloaded from the Association's website ( www.parkinsonpoly.com) or ask your doctor or local patient association about the card.

Click here to see the question card.

Effective treatment of wearing-off

"Wearing-off can be treated very successfully," according to Professor Stocchi. There are several ways to increase the 'on time' with levodopa. The principle approach is to improve and smoothen out the delivery of dopamine to the brain and provide more continuous dopaminergic stimulation. There are different treatment strategies your doctor may propose to you:

• He may recommend adding another drug on to levodopa which could be either a COMT inhibitor such as entacapone (either on its own or in a combination tablet) or tolcapone, a dopamine agonist or a MAOB inhibitor. COMT inhibitor and MAO inhibitor can be added even if the patient experiencing wearing off is already taking levodopa plus a dopamine agonist.
• Alternatively, you may be given a controlled release levodopa, that releases the drug slowly over time but the response can be less predictable than with other levodopa formulations.
• A further approach could be to change the timing of when you take your medication, increase the dose of levodopa or to take it more often. This strategy is very common but is not very successful in the long run.

Coping strategies

There are also things you can do to help yourself with wearing-off, in addition to seeing your doctor and optimizing your drug treatment. Tom finds it best to sit down and do nothing while he is suffering from wearing-off symptoms. "If I try to do things and can't, I just get frustrated and that makes me worse. I just try to sit back, relax and go with the flow." In contrast, Marian finds it helps to keep busy - if he is out and about, or talking with friends then he seems to be able to cope with wearing-off better than if he is at home on his own.

Keeping healthy can help you feel better generally. Tom recommends regular exercise (such as walking or swimming), eating a healthy diet and getting enough rest. Marian also finds exercise beneficial. Stress can also increase the risk of wearing-off sooner, Tom has found. But despite his wearing-off, he managed to walk right round the coastline of Britain last year. "When I suffered from wearing-off I just sat on the ground and waited until it had finished. It was tough, but it was fantastic."

Source

• Susan J. Mayor, BSc, MSc, PhD, is a freelance medical writer based in London.

Related Links
Managing Parkinson's 'Wearing-Off' Symptoms - Part I
European Parkinson's Disease Association
Another way to tackle Parkinson's?

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