Advertisement

Clinical approach to nonmotor sensory fluctuations in Parkinson's disease

Published:August 29, 2011DOI:https://doi.org/10.1016/j.jns.2011.07.056

      Abstract

      Many nonmotor fluctuations (NMFs) may occur in addition to the classic motor fluctuations (MFs) in patients with Parkinson's disease (PD) within several years of initiation of dopaminergic treatment. Patients can experience these NMFs in the “on” and/or “off” periods. NMFs can be divided into three groups: Autonomic, cognitive/psychiatric, and sensory. Nonmotor sensory fluctuations (NMSFs) occurring in association with “on” period are more frequently recognized than those in the “off” state. NMSFs commonly reported include pain, numbness, paresthesia/dysesthesia, akathisia, rest-legs syndrome (RLS), dyspnea, and internal tremor (IT).
      Proposed treatments of NMSFs are based on whether they occur during “off” or “on” state. These include reduction of dopaminergic medication, use of long-acting dopamine agonists or controlled released levodopa (LD), surgical intervention, and/or targeted pharmacological intervention to minimize dopaminergic side effects. NMSFs might be related to dopaminergic mechanisms although difficulty in managing these symptoms with dopaminergic therapy suggests a different pathway. Conclusion: Recognition of NMSFs is important in the care of patients with Parkinson disease to prevent unnecessary interventions and for appropriate medication regimen adjustments.

      Keywords

      To read this article in full you will need to make a payment

      Purchase one-time access:

      Academic & Personal: 24 hour online accessCorporate R&D Professionals: 24 hour online access
      One-time access price info
      • For academic or personal research use, select 'Academic and Personal'
      • For corporate R&D use, select 'Corporate R&D Professionals'

      Subscribe:

      Subscribe to Journal of the Neurological Sciences
      Already a print subscriber? Claim online access
      Already an online subscriber? Sign in
      Institutional Access: Sign in to ScienceDirect

      References

        • Raudino F.
        Nonmotor off in Parkinson's disease.
        Acta Neurol Scand. 2001; 104: 312-315
        • Witjas T.
        • Kaplan E.
        • Azulay J.P.
        Nonmotor fluctuations in Parkinson's disease: frequent and disabling.
        Neurology. 2002; 59: 408-413
        • Gunal D.I.
        • Nurichalici K.
        • Tuncer N.
        • Bekiroglu N.
        • Aktan S.
        The Clinical profile of nonmotor fluctuations in Parkinson's disease patients.
        Can J Neurol Sci. 2002; 29: 61-64
        • Hillen M.E.
        • Sage J.I.
        Nonmotor fluctuations in patients with Parkinson's disease.
        Neurology. 1996; 47: 1180-1183
        • Susan H.F.
        • Lang A.E.
        Motor and nonmotor fluctuations.
        in: Hand book of Clinical Neurology. Elsevier, Edinburgh-Toronto2007: 159-184
        • Sage J.I.
        • Mark M.H.
        Basic mechanisms of motor-fluctuations.
        Neurology. 1994; 44: 10-14
        • Sage J.I.
        • Mark M.H.
        • Mc Hale D.M.
        • Sonsalla P.K.
        • Vitagliano D.
        Benefits of monitoring plasma Levodopa in Parkinson's disease patients with drug-induced chorea.
        Ann Neurol. 1991; 29: 623-628
        • Riley D.E.
        • Lang A.E.
        The spectrum of Levodopa-related fluctuations in Parkinson's disease.
        Neurology. 1993; 43 (1495-64)
        • Bayulkem K.
        • Lopez G.
        Nonmotor fluctuations in Parkinson's disease: Clinical spectrum and classification.
        J Neurol Sci. 2010; 289: 89-92
        • Wooten G.F.
        Progress in understanding the pathology of treatment-related fluctuations In Parkinson's disease.
        Ann Neurol. 1988; 24: 363-365
        • Sage J.I.
        Fluctuations of nonmotor symptoms. Parkinson's disease, diagnosis and clinical management.
        Demos. 2008; 47 (New York): 585-592
        • Ali M.A.
        • Haque A.
        • Anwarullah A.K.M.
        • Ahmed Q.
        Pattern of non-motor fluctuations in patients of Parkinson's disease.
        Taj. 2007; 2: 116-121
        • Koller W.C.
        Sensory symptoms in Parkinson's disease.
        Neurology. 1984; 38: 957-959
        • Schalt G.D.
        Pain in Parkinson's disease.
        Pain. 1985; 22: 407-411
        • Goetz C.G.
        • Tanner C.M.
        • Levy M.
        • Wilson R.S.
        • Garron D.C.
        Pain in Parkinson's sisease.
        Mov Disord. 1986; 1: 45-49
        • Quinn N.P.
        • Koller N.C.
        • Lang A.E.
        • Marsden C.D.
        Painful Parkinson's disease.
        Lancet. 1986; 1: 1366-1369
        • Quinn N.P.
        Classification of fluctuations in patients with Parkinson's disease.
        Neurology. 1998; 51: S25-S29
        • Ford B.
        • Luis E.D.
        • Greene P.
        • Fahn S.
        Oral and genital pain syndromes in Parkinson's Disease.
        Mov Disord. 1996; 11: 421-426
        • Lang A.E.
        • Johnson K.
        Akathisia in idiopathic Parkinson's disease.
        Neurology. 1987; 37: 477-481
        • Poewe W.
        • Hogl B.
        Akathisia, restless legs and periodic movements in sleep in Parkinson's disease.
        Neurology. 2004; 63: S13-S16
        • Comella C.L.
        • Goetz C.G.
        Akathisia in Parkinson's disease.
        Mov Disord. 1994; 9: 545-549
        • Vincen W.G.
        • Daraway C.M.
        • Casio M.G.
        Reversibility of upper airway obstruction after Levodopa therapy in Parkinson's disease.
        Chest. 1989; 96: 210-212
        • Weiner P.
        • Inzelberg R.
        • Davidovich A.
        • Nisipeanu P.
        • Magadle R.
        • Berar-Yanay N.
        Respiratory muscle performance and perception of dyspnea in Parkinson's disease.
        Can J Neurol Sci. 2002; 29: 68-72
        • Shullmann L.M.
        • Singer C.
        • Bean J.A.
        Internal tremor in patients with Parkinson's disease.
        Mov Disord. 1996; 1: 3-7
        • Snider S.R.
        • Fahn S.
        • Isgreen W.P.
        • Cote L.S.
        Primary sensory pain symptoms in parkinsonism.
        Neurology. 1976; 26: 423-429
        • Lees A.J.
        Dopamin agonists in Parkinson's disease: a look at apomorphine.
        Fundam Clin Pharmacol. 1993; 7: 121-128
        • Factor S.A.
        • Brown D.L.
        • Molho E.S.
        Subcutaneous apomorphine injections as a treatment for intractable pain in Parkinson's disease.
        Mov Disord. 2000; 15: 167-169
        • Reuter I.
        • Ellis C.M.
        • Chadhuri R.K.
        Nocturnal subcutaneous apomorphine infusion in Parkinson's disease and restless legs syndrome.
        Acta Neurol Scand. 1999; 100: 163-167
        • Sage L.I.
        Pain in Parkinson's disease.
        Curr Treat Options Neurol. 2004; 6: 191-200
        • Lees A.J.
        A sustained-release formulation of L-dopa (Madopar HBS) in the treatment of Nocturnal and early-morning disabilities in Parkinson's disease.
        Eur Neurol. 1987; 27: 126-134
        • Pachetti C.
        • Albani G.
        • Martignoni E.
        • Godi L.
        • Alfonsi E.
        • Nappi G.
        “Off” painful dystonia in Parkinson's disease treated with botilinum toxin.
        Mov Disord. 1995; 10: 333-336
        • Lees A.J.
        • Shaw K.M.
        • Stern G.M.
        Baclofen in Parkinson's disease.
        J Neurol Neurosurg Psychiatry. 1978; 41: 707-708
        • Quinn N.
        • Marsden C.D.
        Lithium for painful dystonia in Parkinson's disease.
        Lancet. 1986; 1: 1377
        • Linazasoro G.
        • Masso J.F.M.
        • Duarez J.A.
        Nocturnal akathisia in Parkinson's disease: treatment with clozapine.
        Mov Disord. 1993; 8: 171-174
      1. Honey, CR; Stoessel, AJ; Tsui, K; Schulzer, M; Calne, DB, Unilateral pallidotomy for reduction of parkinsonian pain. 1999; 91: 198–201.

        • Krack P.
        • Pollack P.
        • Limousin P.
        • Benazzouz A.
        • Deuscl G.
        • Benabid A.L.
        From off-period dystonia to peak-dose chorea. The clinical spectrum of varying subthalamic nucleus activity.
        Brain. 1999; 122: 1133-1146
        • Loher T.J.
        • Burgunder J.M.
        • Pohle T.
        • Weber S.
        • Sommerhalder R.
        • Krauss J.K.
        Long-term pallidal deep brain stimulation in patients with advanced Parkinson disease: 1 year follow-up study.
        J Neurosurg. 2002; 96: 844-853
        • Funkiewiez A.
        • Ardouin C.
        • Caputo E.
        • Krack P.
        • Fraix V.
        • Klinger H.
        Long term effects of bilateral subthalamic nucleus stimulation on cognitive function, mood and behavior in Parkinson's disease.
        J Neurol Neurosurg Psychiatry. 2004; 75: 834-839
        • Stacy M.
        • Bowron A.
        • Guttman M.
        • Hauser R.
        • Hughes K.
        • Larsen J.P.
        • et al.
        Identification of motor and nonmotor wearing-off in Parkinson's disease: comparison of a patient questionnaire versus a clinician assessment.
        Mov Disord. 2005; 20: 726-733
        • Allen R.P.
        • Picchietti D.
        • Hening W.A.
        • Trenkwalder C.
        • Walters A.S.
        • Montplaisi
        • et al.
        Restless legs syndrome: diagnostic criteria, special considerations, and epidemiology. A report from the restless legs syndrome diagnosis and epidemiology workshop at the National Institutes of Health.
        Sleep Med. Mar 2003; 4: 101-119