Overview
Off-periods in Parkinson disease refer to times when the medications used to control Parkinson symptoms stop working effectively, causing a return of symptoms like tremor, stiffness, slowness of movement, and difficulty walking. In Parkinson disease, the brain gradually loses cells that produce dopamine, a chemical messenger important for smooth, coordinated movement. Medications like levodopa help replace dopamine, but over time — often after several years of treatment — the effect of each dose may wear off before the next dose is due, or the medication may kick in unpredictably. These are called 'off-periods' or 'motor fluctuations.' This specific condition focuses on off-periods that do not respond well to adjustments in oral medications, meaning that changing the dose, timing, or type of pills taken by mouth has not been enough to control these episodes. During off-periods, patients may experience sudden freezing, severe tremor, muscle rigidity, anxiety, sweating, and difficulty speaking or swallowing. The treatment landscape for refractory off-periods has expanded significantly in recent years. Options now include non-oral rescue therapies such as subcutaneous apomorphine injections, inhaled levodopa, sublingual apomorphine films, continuous subcutaneous apomorphine infusion pumps, and intestinal gel infusions of levodopa-carbidopa. Deep brain stimulation surgery is another option for eligible patients. These approaches bypass the digestive system, which can be unreliable in advanced Parkinson disease.
Key symptoms:
Sudden return of tremor or shakingMuscle stiffness and rigiditySlowness of movement or feeling frozen in placeDifficulty walking or shuffling gaitTrouble speaking or slurred speechDifficulty swallowingAnxiety or panic during off-periodsSweating or feeling overheatedPain or cramping in musclesMood changes including depression or irritabilityFatigue and low energyUnpredictable switching between good and bad periodsDifficulty with fine motor tasks like buttoning clothesBalance problems and risk of falling
Multifactorial
Caused by a mix of several genes and environmental factors
Adult
Begins in adulthood (age 18 or older)
FDA & Trial Timeline
1 eventExtraneal (with 7.5% Icodextrin) Peritoneal Dialysis Solutio: FDA approved
For use as a single daily exchange for the long (8-16 hour) dwell during continuous ambulatory peritoneal dialysis (CAPD) or automated peritoneal dialysis (APD) for the management of chronic renal failure.
Data sourced from FDA regulatory filings and ClinicalTrials.gov. Updated periodically.
Treatments
2 availableLivtencity
LIVTENCITY is indicated for the treatment of adults and pediatric patients (12 years of age and older and weighing at least 35 kg) with post-transplant cytomegalovirus (CMV) infection/disease that is …
LIVTENCITY is indicated for the treatment of adults and pediatric patients (12 years of age and older and weighing at least 35 kg) with post-transplant cytomegalovirus (CMV) infection/disease that is refractory to treatment (with or without genotypic resistance) with ganciclovir, valganciclovir, cidofovir or foscarnet
Extraneal (with 7.5% Icodextrin) Peritoneal Dialysis Solutio
For use as a single daily exchange for the long (8-16 hour) dwell during continuous ambulatory peritoneal dialysis (CAPD) or automated peritoneal dialysis (APD) for the management of chronic renal fai…
For use as a single daily exchange for the long (8-16 hour) dwell during continuous ambulatory peritoneal dialysis (CAPD) or automated peritoneal dialysis (APD) for the management of chronic renal failure.
Clinical Trials
View all trials with filters →No actively recruiting trials found for Off-periods in Parkinson disease not responding to oral treatment at this time.
New trials open frequently. Follow this disease to get notified.
Specialists
View all specialists →No specialists are currently listed for Off-periods in Parkinson disease not responding to oral treatment.
Treatment Centers
8 centersBaylor College of Medicine Rare Disease Center ↗
Baylor College of Medicine
📍 Houston, TX
🏥 NORDStanford Medicine Rare Disease Center ↗
Stanford Medicine
📍 Stanford, CA
🔬 UDNNIH Clinical Center Undiagnosed Diseases Program ↗
National Institutes of Health
📍 Bethesda, MD
🔬 UDNUCLA UDN Clinical Site ↗
UCLA Health
📍 Los Angeles, CA
🔬 UDNBaylor College of Medicine UDN Clinical Site ↗
Baylor College of Medicine
📍 Houston, TX
🔬 UDNHarvard/MGH UDN Clinical Site ↗
Massachusetts General Hospital
📍 Boston, MA
🏥 NORDMayo Clinic Center for Individualized Medicine ↗
Mayo Clinic
📍 Rochester, MN
👤 Mayo Clinic Center for Individualized Medicine
🏥 NORDUCLA Rare Disease Day Program ↗
UCLA Health
📍 Los Angeles, CA
Financial Resources
1 resourcesTravel Grants
No travel grants are currently matched to Off-periods in Parkinson disease not responding to oral treatment.
Community
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Caregiver Resources
NORD Caregiver Resources
Support, advocacy, and financial assistance for caregivers of rare disease patients.
Mental Health Support
Rare disease caregiving can be isolating. Connect with counseling and peer support.
Family & Caregiver Grants
Financial assistance programs specifically for caregivers of rare disease patients.
Social Security Disability
Learn how rare disease patients may qualify for SSDI/SSI benefits.
Questions for your doctor
Bring these to your next appointment
- Q1.What non-oral treatment options are available for my off-periods, and which would you recommend for me?,Am I a candidate for deep brain stimulation surgery?,How can I better track my on and off times to help guide treatment decisions?,Are there any clinical trials for new treatments for refractory off-periods that I could participate in?,What should my caregiver do if I have a severe off-period and cannot move or swallow?,Could my current medications be contributing to the unpredictability of my off-periods?,What support services — physical therapy, occupational therapy, mental health support — do you recommend?
Common questions about Off-periods in Parkinson disease not responding to oral treatment
What is Off-periods in Parkinson disease not responding to oral treatment?
Off-periods in Parkinson disease refer to times when the medications used to control Parkinson symptoms stop working effectively, causing a return of symptoms like tremor, stiffness, slowness of movement, and difficulty walking. In Parkinson disease, the brain gradually loses cells that produce dopamine, a chemical messenger important for smooth, coordinated movement. Medications like levodopa help replace dopamine, but over time — often after several years of treatment — the effect of each dose may wear off before the next dose is due, or the medication may kick in unpredictably. These are ca
How is Off-periods in Parkinson disease not responding to oral treatment inherited?
Off-periods in Parkinson disease not responding to oral treatment follows a multifactorial inheritance pattern. Genetic counseling can help families understand recurrence risk and testing options.
At what age does Off-periods in Parkinson disease not responding to oral treatment typically begin?
Typical onset of Off-periods in Parkinson disease not responding to oral treatment is adult. Age of onset can vary across affected individuals.
What treatment and support options exist for Off-periods in Parkinson disease not responding to oral treatment?
1 patient support program are currently tracked on UniteRare for Off-periods in Parkinson disease not responding to oral treatment. See the treatments and support programs sections for copay assistance, eligibility, and contact details.