Do Parkinson's Disease Symptoms Come and Go Over Time?

More than 10 million people worldwide live with Parkinson’s disease. In the United States, 60,000 new cases will be diagnosed this year.

The degenerative central nervous system disease is marked by tremors, muscular rigidity, speech and handwriting changes, and slow, inaccurate movement. There is currently no cure, but there are treatment options to manage symptoms.

The most common medication for Parkinson’s is Sinemet, which aims to replace the brain’s declining production of a neurotransmitter called dopamine.

Since the brain makes less dopamine over time, the dose and timing of Sinemet are moving targets. A specialist can help you re-adjust this to prevent symptoms from returning between doses.

Understanding the symptoms

Parkinson’s impacts many systems in the body. Symptoms of the disease differ from person to person and usually develop slowly over time. It can be easy to notice someone with untreated Parkinson’s because of the external signs and symptoms.

Those motor symptoms include:

Progressively small handwriting
Shuffling gait
Soft speech
Tremor (but not always)
Hand or foot cramping
Drooling
Swaying movements (dyskinesia)
Masked face (hypomimia)

In people with Parkinson’s, cells that produce a neurotransmitter called dopamine are impaired. The body’s nervous system uses dopamine, sometimes called a chemical messenger, to relay messages between nerve cells.

As Parkinson’s progresses, more dopamine-producing brain cells become disabled, and the brain eventually stops producing enough of the neurotransmitter. This causes worsening problems with movement.

While it is a disease that impairs movement, Parkinson’s also involves non-motor symptoms. Observers may not be able to see these hidden symptoms, but it is important to know they are common and can be more troubling than motor symptoms.

According to the Parkinson’s Foundation, non-motor symptoms can include:

Cognitive changes
Constipation
Early satiety (getting full easily with small meals)
Excessive sweating
Fatigue
Increase in dandruff (seborrheic dermatitis)
Hallucinations and delusions
Lightheadedness
Loss of sense of smell or taste
Mood disorders
Pain
Sexual problems
Sleep disorders
Urinary urgency, frequency and incontinence
Vision problems

Why symptoms come and go

Sinemet is considered the gold standard and most commonly prescribed medication for Parkinson’s. It helps replace dopamine, which can ease motor problems. However, as the disease progresses, the beneficial effects of the drug often wear off before it is time to take another dose.

This creates what is sometimes called the “on-off phenomenon” of Parkinson’s. The period when levodopa has a positive effect on Parkinson’s symptoms is called on-time. Once the medication stops working, a so-called off-episode starts, during which symptoms recur.

Over time, the body’s ability to convert Sinemet into dopamine decreases, meaning the helpful effects of the medication will wear off more quickly, and off episodes will arrive more rapidly. The symptoms can come and go suddenly, prompting some to compare it to turning a light switch on and off. Doctors sometimes shorten the interval between Sinemet doses or prescribe additional medications to provide relief during off periods. An advanced therapy called deep brain stimulation can sometimes help with this issue. A trained specialist in movement disorders best manages this on-off phenomenon.

Over the past 60 years, the Parkinson’s Foundation has invested more than $368 million in research and clinical care. The Michael J. Fox Foundation, a New York-based non-profit formed in 2000 by the noted Hollywood actor who was diagnosed with Parkinson’s at age 29, has boosted fundraising and public awareness efforts.

A local branch of that organization, Kickin’ Parkinson’s, was formed over a decade ago by former Louisiana State Representative Quentin Dastugue and his family. Dastugue was diagnosed with the disease in 2009. The local organization has raised around $2 million, making it one of the country’s most successful chapters of the Fox Foundation. All proceeds go toward helping those with the disease and finding a cure.