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

Top Twelve Tips for Parkinson's Disease Care

  1. PD medicines matter – prescribe the same doses AND TIMES as used at home
  2. PD medicines matter – give on time, do not omit
    • If medication is not available on the ward - try Pulteney Ward +/- stock list.
    • Contact on call Pharmacist if cannot locate supply
    • If unable to swallow, seek urgent review and if needed, use this link
  3. Swallow function may worsen when unwell – especially if allowed to be 'off'
  4. Never give haloperidol, metaclopramide (Maxalon) or prochlorperazine (Stemetil)
    • They block the action of PD medicines
  5. Symptoms and function can vary with PD drug blood levels (called "on/ off" fluctuations)
    • Check the medicine chart to see when the last PD dose was given and the next dose is due
  6. Identify patients with "on/off" fluctuations - consider implications for care plans
    • Ask if they notice a change if they are late with their medicines
    • Perform functional assessments just before and an hour after a dose
    • Know how to distinguish tremor from dyskinesia
  7. Communication can be difficult – allow time
  8. Postural hypotension is common – check blood pressure lying and standing
    • Take care when starting medicines that lower blood pressure
  9. Problems at night are common – keep a night chart
  10. Hallucinations may occur when unwell - ask about them and seek advice
    • Avoid using Anticholinergics eg hyoscine or Oxybutinin
  11. Bed rest is dangerous! Increases rigidity and the risk of chest infections
    • Keep mobile – target when 'on' to maximise benefit
    • Refer to Physiotherapy early
    • 'Cues' can facilitate movement e.g. counting or verbal prompt for a "big step"
  12. Patients and carers live with PD – use their expertise
    • build partnerships with patients and encourage them to remind nurses about their next dose 30 minutes before it is due

Further information

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