Kemal Bayulkem1, Grisel Lopez. 1. Cerrahpsa Faculty of Medicine, University of Istanbul, Department of Neurology, Istanbul, Turkey. kbayulkem@hotmail.com
Abstract
UNLABELLED: The majority of patients with Parkinson's disease (PD) on levodopa (LD) treatment usually experience motor fluctuations (MFs) within several years of initiation of treatment. Besides the classic MFs, many nonmotor fluctuations (NMFs) may occur in PD. NMFs appear both in the "on" state and "off" state. However, the clinical spectrum and the frequency of these symptoms are not well recognized. NMFs are usually mild and less disabling than MFs but sometimes can lead to unnecessary tests and therapies. NMFs occurring in association with the "on" state are better known and therefore more frequently diagnosed than those occurring in the "off" state. NMFs can be classified into three groups: autonomic, cognitive/psychiatric, and sensory. They include gastrointestinal and urinary symptoms, drenching sweats, temperature and blood-pressure changes, depression, anxiety, hallucinations, hypomania, moaning/screaming, confusion, cognitive dysfunction, sexual deviations and dopamine dysregulation syndrome (DDS), pain, akathisia, internal tremor, numbness/parasthesia, and dyspnea. CONCLUSION: Recognition of NMFs may prevent unnecessary diagnostic tests and may lead to treatment modifications aimed to minimize their occurrence.
UNLABELLED: The majority of patients with Parkinson's disease (PD) on levodopa (LD) treatment usually experience motor fluctuations (MFs) within several years of initiation of treatment. Besides the classic MFs, many nonmotor fluctuations (NMFs) may occur in PD. NMFs appear both in the "on" state and "off" state. However, the clinical spectrum and the frequency of these symptoms are not well recognized. NMFs are usually mild and less disabling than MFs but sometimes can lead to unnecessary tests and therapies. NMFs occurring in association with the "on" state are better known and therefore more frequently diagnosed than those occurring in the "off" state. NMFs can be classified into three groups: autonomic, cognitive/psychiatric, and sensory. They include gastrointestinal and urinary symptoms, drenching sweats, temperature and blood-pressure changes, depression, anxiety, hallucinations, hypomania, moaning/screaming, confusion, cognitive dysfunction, sexual deviations and dopaminedysregulation syndrome (DDS), pain, akathisia, internal tremor, numbness/parasthesia, and dyspnea. CONCLUSION: Recognition of NMFs may prevent unnecessary diagnostic tests and may lead to treatment modifications aimed to minimize their occurrence.
Authors: Seong-Beom Koh; Jae Woo Kim; Hyeo-Il Ma; Tae-Beom Ahn; Jin Whan Cho; Phil Hyu Lee; Sun Ju Chung; Joong-Seok Kim; Do Young Kwon; Jong Sam Baik Journal: J Clin Neurol Date: 2012-12-21 Impact factor: 3.077