Parkinson’s Disease OFF Episodes: Medication Not Working Well

What are Parkinson’s disease OFF episodes and why do they happen? Let’s explore the Parkinson’s ON/OFF phenomenon as well as possible treatment options.

Parkinson’s disease OFF episodes occur in people who take medication containing levodopa for Parkinson’s disease symptoms. An OFF episode refers to the time when levodopa stops working as effectively as it should, which typically occurs in the later stages of the disease. This causes a return of symptoms such as slowed movement and Parkinson’s gait. Parkinson's disease patients often feel better during ON periods when they have just taken a dose of levodopa, but their symptoms may return while they are waiting for their next dose. So, what exactly are Parkinson’s disease OFF episodes and why do they happen?

Parkinson’s Disease OFF Episodes: What are OFFs?

Parkinson’s disease OFF episodes refers to periods of the day when Parkinson’s medication does not work well, causing the worsening of Parkinsonian symptoms. Typically, patients have higher occurrences of OFFs in the morning following a treatment-free period overnight. The medical term for this is morning akinesia.

OFF episodes are part of the Parkinson’s disease ON/OFF phenomenon that affects patients in the late stages of Parkinson’s. This happens when patients have been taking levodopa for 3-5 years, and the medication stops working as well as it did.

Characteristics of OFF episodes include motor fluctuations such as:

  • Stiffness
  • Slowed movement
  • Frozen gait (inability to move at all for seconds or minutes)
  • Difficulty speaking and/or slurred speech

These symptoms are caused by the Parkinson’s disease medication wearing off, usually around 3 hours after a dose or overnight. By contrast, ON periods can feel like someone has turned on a light. You may suddenly feel more energetic and able to move around freely. ON periods are when you feel at your most capable because your symptoms are controlled.

Unless your doctor makes changes to your medication, you will experience more OFF episodes than ON episodes between doses. Thankfully, there are various ways to manage Parkinson’s disease OFF episodes when your Parkinson’s medication is not working.

How to Manage Parkinson’s Disease OFF Time

Parkinson's disease OFF time can be both upsetting and debilitating. You may not understand why your symptoms have returned, and you may find it difficult to go about your daily life during these episodes. Here are some ways you can manage Parkinson's disease OFF time:

  • Medication: Your doctor may prescribe a new levodopa drug, such as one with controlled release to make your ON periods last longer. You might have to take other medications on top of your current prescription to help you manage your symptoms. Alternatively, you may need to increase your existing medication or shorten your internals between doses.
  • Surgery: If your symptoms are severe and don't respond to medication, your doctor may suggest surgery. Brain surgery for Parkinson's disease is called deep brain stimulation and involves inserting electrodes inside the brain that connect to a neurotransmitter in your chest. The neurotransmitter will send electrical stimulation to the parts of your brain that control movement. Many patients see a marked change in symptoms after having DBS.
  • Diet: Most doctors recommend taking levodopa medicines at least 30 minutes before you eat. This is because protein can slow down the absorption of the drug, making it less effective. Eating a healthy balanced diet is vital for all areas of health, so your doctor may refer you to a dietician to ensure you stay physically well.
  • Scheduling: In the later stages of Parkinson’s disease, it’s not uncommon for medications to stop working as effectively. For this reason, specialists often suggest planning your day around your ON and OFF periods so you can make the most of your ON time. This might mean you avoid certain activities during OFF episodes or ensure there is someone to care for you when your symptoms are severe.
  • Symptom tracking: Whether or not you’re experiencing OFF episodes, it can be useful to track your symptoms so you can give your healthcare provider a full view of your condition. Certain Parkinson’s disease medications can affect the memory, so it’s worth writing down symptoms and side-effects if you think you will forget them.
  • Complementary and homeopathic therapies: Exercises such as yoga, tai chi and massage have been found to be helpful for those with Parkinson's disease. Multiple studies have found a link between stress and the worsening of PD symptoms, so finding ways to relax is incredibly important.

While Parkinson's disease OFF episodes can be distressing, they don't signal the end of successful treatment. If your Parkinson's disease medication is wearing off, it's important to consult your doctor right away. He or she will be able to tailor your treatment plan to help you deal with your symptoms and manage your OFF time more effectively.

article references

APA Reference
Smith, E. (2022, January 28). Parkinson’s Disease OFF Episodes: Medication Not Working Well, HealthyPlace. Retrieved on 2024, June 24 from

Last Updated: January 27, 2022

Medically reviewed by Harry Croft, MD

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