“Off” is a term doctors and researchers use frequently in Parkinson’s care and research. But people with Parkinson’s disease (PD) may be less familiar with this term or what it means for them.
Motor fluctuations are “off” times, when medication — namely levodopa (the “gold standard” treatment for Parkinson’s) — is not working optimally and Parkinson’s symptoms (motor and/or non-motor) return. “Off” periods are more common as the disease progresses and people take medication for a longer period of time.
Management options include dietary and medication adjustments and, for some, surgical therapy (such as deep brain stimulation). Additional therapies that may help avoid “off” periods or quickly alleviate them may be available within the next few years; several are in the later stages of the development pipeline. Treatment regimens are, however, unique to each individual and must be decided upon after careful consideration with one’s personal physician.
Watch this video from Rachel Dolhun Rachel Dolhun, MD, Movement Disorder Specialist and Vice President of Medical Communications at The Michael J. Fox Foundation
Treating “off” time
Treating “off” begins with looking at how you actually take your medications (not just how they’re prescribed). Taking levodopa doses later than scheduled or skipping them can lead to “off.” (Setting an alarm may help.) Combining levodopa with meals, especially high-protein foods, also can contribute to “off.” If you take medication on time and separate from meals, your doctor may adjust medication dose or timing (increasing levodopa to four times a day from three, for example, if your symptoms come back throughout the day) or add medication.
Improving “off” medication
For unpredictable “off ” times, doctors also may prescribe an apomorphine injection (a drug that works like dopamine, the brain chemical that goes missing in PD) to use as needed. This is currently the only available on-demand therapy for “off.” But two new MJFF-backed therapies, under U.S. Food and Drug Administration review at the time of this writing, may soon expand options. A reformulation of apomorphine — an under-the-tongue dissolvable strip — and a levodopa inhaler may offer novel solutions to treat “off” as needed, in addition to scheduled medications. If approved, these drugs would provide new routes to rapidly reverse symptoms, addressing “off” more broadly in a potentially wider population of people with Parkinson’s.