Opinion|Videos|April 23, 2025

Off Fluctuations in Parkinson Disease

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

Panelists discuss how off fluctuations in Parkinson disease become increasingly prevalent as the disease progresses, significantly impacting patient quality of life through reduced mobility, independence, and overall well-being.

Video content above is prompted by the following:

Prevalence of Off Fluctuations and Quality-of-Life Impact

Off Fluctuations Prevalence:

Approximately 40% of patients experience motor fluctuations after 4 to 6 years of levodopa therapy
By 10 years of treatment, up to 90% of patients develop off episodes (Aradi 2020)
Off periods increase in frequency and duration as disease progresses
Early fluctuations may be end-of-dose wearing off, progressing to unpredictable on-off phenomena

Quality-of-Life Impact:

Progressive deterioration in activities of daily living and independence
Increased caregiver burden and health care utilization
Significant psychological impact: anxiety, depression, social isolation
Mobility limitations affecting employment, social interactions, and self-care
Sleep disturbances and fatigue compound functional limitations

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