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Identification and treatment of wearing off in Parkinson's disease

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Author(s): Dr James M Fisher | Prof Richard W Walker

Journal: Scottish Universities Medical Journal
ISSN 2049-8454

Volume: 2;
Issue: 2;
Start page: 58;
Date: 2013;
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Keywords: Parkinson’s Disease |  Wearing off |  Motor Fluctuations 

ABSTRACT
Parkinson’s disease (PD) is a neurodegenerative disorder classically characterised by motor symptoms. In recent years there has been increased recognition of the non-motor symptoms of PD. ‘Wearing off’, worsening of a patient’s symptoms before the next dose of their medication is due, may be seen with advancing disease. Management of wearing off may include modification of a patient’s levodopa medication regimen or prescription of an additional agent. The onset of such motor complications may be delayed by the use of levodopa-sparing agents or by keeping levodopa doses to a minimum. Wearing off may be evaluated via patient histories, diaries, rating scales or questionnaires. The efficacy of these assessment methods is however limited by recall bias and their inherent subjectivity. A number of potential objective methods of symptom assessment in PD have been explored, with body-worn accelerometers showing the most potential. The application of advanced computational algorithms to the data captured by accelerometers may enable the complexity of human movement to be appreciated. Such technology may, in future, allow objective identification of wearing off and thus provide the clinician with vital additional information on which to base clinical decisions.

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