Spontaneous wriggling or writhing movements which can occur when the medicine is working (i.e. the patient is 'on').
A rhythmic, oscillating movement, most commonly of the hands and or limbs.
When the patient is adequately treated and movements are reasonably fluent and spontaneous.
When when the patient's medication has worn off and movements are slow, deliberate and difficult. Other less visible symptoms of pain and distress may be a feature for some patients.
A noticeable transition from 'on' to 'off' occurring between doses of medication.
An umbrella term for the motor complications of more 'brittle' advanced disease. Patients can fluctuate from 'off', to 'on' and "on with dyskinesia." The change may be gradual or a sudden switch.

For Clinicians

Parkinson's Disease

The First 24 Hours

Parkinson's Disease Care Bundle (Internal Page)

Patient identified as having PD
Inform Parkinson's Admission
Voicemail ext 1028
Check with:

Patient & family


Parkinson's Service

Parkinson's Nurse Specialist

Information available re usual PD medication regime?
Check when last PD medicine dose taken - and the next dose due
Missed dose or may not be clerked before the next dose due?
Alert doctor to prescribe
Check Ward stock list (intranet)

Out of hours: check with Pulteney Ward, intranet stock list and Emergency Cupboard. Call OOH Pharmacy if necessary

In hours: as above or via Pharmacy.
If moving ward, highlight when next dose is due and any medicine supply issues.
Medication available and prescribed (NB Same dose AND TIMES as taken at home)
Consider self-medication on PD drugs
Give PD medication on time - do not omit
Ask patients to remind you 30 mins before, consider timer if complex

  • PD medicines matter – "on/off" fluctuations which are unique to PD
  • Spectrum
    • Mild increase in PD symptoms if medication late
    • Very marked change in care needs from "on / off"
    • 'Off' symptoms can include pain / breathlessness / anxiety
    • Patient assessment when 'off' will be misleading
  • The more complex the medicine regime – the more likely that "Get it on time" is crucial
  • Bed rest is dangerous and prolongs length of stay – early referral to Physiotherapy
  • People with PD need time for communication and nutrition
  • Swallow may worsen when unwell – or if un-medicated
  • Know how to access advice - criteria for urgent review

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