ABSTRACT
The triad of rest tremor, slowness of movement (bradykinesia), and limb rigidity constitute the clinical hallmarks of idiopathic Parkinson’s Disease (PD). However, the majority of patients will develop an increasing number of more complex symptoms over time. These symptoms include variability in the patient’s mobility, so-called motor fluctuations, as well as variability in other non-motor symptoms. Over 70% of patients with PD will develop increasing variability in their motor response to dopaminergic treatment after 5 years. These “motor fluctuations” typically appear insidiously and are often initially unnoticed by the patient. The first evidence of an emerging fluctuating medication response is the “wearing-off” phenomenon, where the patient reports slowing up or increasing stiffness as the time approaches for their next dose of medication. The complexity of evolving motor and non-motor fluctuations in PD poses a significant challenge to the treating clinician.
