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Do Parkinson's Symptoms Come and Go?

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

The most potent medication for Parkinson’s is levodopa, which was developed the late 1960s under the auspices of Swedish scientist Arvid Carlsson, who later won a Nobel Prize for his work. It represented one of the most important breakthroughs in the history of medicine.

Levodopa is almost always given in combination with the drug carbidopa, which prevents the nausea that can be caused by levodopa alone. However, the effectiveness of these medications can wane after a while, causing symptoms to return between doses.

Understanding The Symptoms

Parkinson’s impacts many systems in the body. Symptoms of the disease are different from person to person and usually develop slowly over time. It can be easy to detect someone with untreated Parkinson’s because of the outward 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, which is sometimes referred to as a chemical messenger, to relay messages between nerve cells.

As Parkinson’s progresses, more dopamine-producing brain cells become disabled, and the brain eventually ceases to produce 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 troublesome 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

Levodopa 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 medication often wear off before it is time to take another dose.

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

Over time, the body’s ability to convert levodopa into dopamine decreases, meaning the helpful effects of the medication will wear off more quickly and off episodes will arrive more quickly. The symptoms can come and go with suddenness, prompting some to compare it to turning a light switch on and off. Doctors sometimes shorten the interval between levodopa doses or prescribe additional medications to provide relief during off periods. Sometimes an advanced therapy called Deep Brain Stimulation can help this issue.

This on-off phenomenon is best managed by a trained specialist in movement disorders.
Over the past 60 years, the Parkinson’s Foundation has invested more than $368 million in research and clinical care. Fundraising and public awareness efforts have been boosted by the Michael J. Fox Foundation, a New York based non-profit that was formed in 2000 by the noted Hollywood actor who was diagnosed with Parkinson’s at age 29.

A local branch of that organization called 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.

Learn more about neurology care at Ochsner.

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