Parkinson's symptoms are more prominent during certain times of the day.
Managing Parkinson's Symptoms: A Comprehensive Guide
Living with Parkinson's disease can present challenges, particularly when symptoms worsen throughout the day. To better manage these fluctuations, it is helpful for individuals to keep a record of their symptoms, including when they occur, their severity, and how quickly they come on.
The root causes of these symptom fluctuations, often referred to as "Off" episodes, are multifaceted. They can stem from the wearing-off phenomenon, where the effects of dopamine replacement medications like levodopa become shorter-lived as the disease progresses [2][5]. The ongoing degeneration of dopamine-producing neurons also plays a significant role, reducing the brain's ability to regulate movement and other functions [3][5].
Other factors contributing to Off episodes include variations in medication absorption and metabolism, which can cause uneven dopamine levels [2][5]. Non-motor symptoms, such as anxiety, pain, and depression, can worsen motor symptoms and contribute to overall functional decline [1][4]. Sleep disruption, due to brainstem degeneration, nocturia, rigidity, or medication side effects, can exacerbate daytime symptom fluctuations and fatigue [1].
Fortunately, there are effective management strategies available. Adjusting dopaminergic therapy by using additional or more frequent doses of levodopa or adding medications like COMT inhibitors (e.g., Ongentys) can help prolong and smooth out dopamine effects, reducing off periods [2][5].
Optimizing medication timing by tailoring dosage schedules to individual symptom patterns, including early morning dystonia, helps maintain more consistent symptom control [2]. Addressing non-motor symptoms through pharmacologic and nonpharmacologic means improves overall symptom burden and quality of life [4]. Managing sleep disorders by balancing medications that affect sleep and treating nocturnal symptoms reduces daytime symptom worsening [1].
A multidisciplinary, patient-centered approach with realistic expectations and ongoing adjustments is critical as symptom patterns evolve over time [4].
In addition to medication adjustments, lifestyle changes can also help manage symptoms. For instance, eating smaller, more frequent meals throughout the day can help manage Off episodes during the day [6]. Making changes to medication dosing and timing, and eating less protein and fat, can also be beneficial [6].
Treatment for sleep issues in Parkinson's patients varies based on the cause and may include continuous positive airway pressure (CPAP) machines, melatonin, sleep hygiene, clonazepam, relaxation therapies, cognitive behavioral therapy (CBT), light therapy, sedatives, and other strategies [7].
For morning bradykinesia and akinesia, options include taking extended-release levodopa, tweaking the timing and dose of levodopa, and eating smaller meals with lower fat and lower protein [8].
Levodopa-induced dyskinesia can be managed or prevented with treatment options such as delaying the introduction of levodopa, taking amantadine, shortening the interval between levodopa doses, taking extended-release levodopa, and other strategies [9].
It is always best to speak with a healthcare professional about sleep issues, stress levels, and any changes in Parkinson's symptoms. People with a long history of motor issues or at advanced stages of Parkinson's have the highest risk of morning akinesia [10].
In conclusion, by understanding the factors contributing to Off episodes and worsening Parkinson’s symptoms throughout the day, and implementing effective management strategies, individuals can improve their quality of life and better manage their symptoms.
- Embracing a holistic approach that includes medical interventions, such as science-backed treatments for managing Parkinson's symptoms, and lifestyle changes can aid in effectively managing chronic diseases like Parkinson's and fostering health and wellness.
- Understanding the scientific basis of medical conditions like Parkinson's, particularly the factors influencing Off episodes, is key to managing the symptoms effectively and maintaining a higher quality of life as part of an overall health-and-wellness routine.
