Opinion|Videos|April 30, 2025

Conversations About Off Time In Patients With Parkinson Disease

Author(s)Stuart H. Isaacson, MD, FAAN, Daniel E. Kremens, MD, JD, Jill Ostrem, MD

Panelists discuss how physicians approach conversations about off time with patients with Parkinson disease, balancing clinical assessment with patient education and shared decision-making.

Episodes in this series

5 experts in this video

EP. 1 Off Fluctuations in Parkinson Disease

5 experts in this video

EP. 2 Adjusting and Changing Treatment Regimens in Parkinson Disease

5 experts in this video

EP. 3 Recognition of Off Episodes in Parkinson Disease

5 experts in this video

EP. 4 Conversations About Off Time In Patients With Parkinson Disease

5 experts in this video

EP. 5 Advanced Treatment Options in Parkinson Disease

5 experts in this video

EP. 6 Adjunctive Treatments and Apomorphine for Treatment of Parkinson Disease

5 experts in this video

EP. 7 Continuous Subcutaneous Apomorphine Infusion (CSAI) and TOLEDO Study in Parkinson Disease

5 experts in this video

EP. 8 CSAI and INFUS-ON Study for Treatment of Parkinson Disease

5 experts in this video

EP. 9 Continuous Subcutaneous Infusion Systems for Parkinson Disease and Patient Selection Criteria

5 experts in this video

EP. 10 Place of Continuous Subcutaneous Infusion Systems in Parkinson Disease Management

5 experts in this video

EP. 11 Clinical Experience With CSAI for Parkinson Disease

5 experts in this video

EP. 12 Place of Recent Approvals in Parkinson Disease Management

5 experts in this video

EP. 13 Patient Conversation and Adoption of CSAI in Clinical Practice

5 experts in this video

EP. 14 Clinical Nurse Educators, Dosing Titrations to Manage Parkinson Disease

Video content above is prompted by the following:

Physician-Patient Communication About Off Time

Structured assessment using validated tools (Movement Disorder Society (MDS), Unified Parkinson's Disease Rating (UPDRS), Wearing Off Questionnaire-9 (WOQ-9), Hauser Diary)
Dedicated time to discuss daily symptom patterns and medication response
Use of accessible language and visual aids to explain pharmacokinetics
Involvement of caregivers to provide collateral information
Setting realistic expectations about treatment goals
Shared decision-making approach to treatment selection
Regular follow-up with focused reassessment of off time
Discussion of impact on quality of life and function, not just motor symptoms
Education about differentiating off symptoms from nonmotor manifestations

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