Treat Parkinson's Motor Fluctuations

Medically Reviewed by Brunilda Nazario, MD on June 29, 2021
3 min read

If your Parkinson's symptoms start to come back after you've been controlling them for years with medicine, you have lots of ways to get help. Work with your doctor to find the right treatment for this problem, called motor fluctuations. You may need to try a different dose of your current drugs, additional medications, lifestyle changes, or other strategies.

The drug levodopa raises dopamine levels in your brain to prevent symptoms like stiffness and tremor. Early in the disease, levodopa should keep your dopamine levels steady from one dose to the next.

Once you've had Parkinson's for many years, your dopamine levels may start to drop between drug doses. When that happens, your symptoms could come back before it's time to take the next dose.

Your doctor can adjust when and how often you take levodopa to avoid these dips in dopamine levels. One strategy is to take smaller doses of levodopa more often during the day. Or you could take a higher dose of the drug the same number of times each day.

Another way to keep your dopamine levels steady is to try a long-acting form of levodopa that delivers a steady dose of the medicine. These include:

  • A patch that you wear on your skin
  • A capsule that slowly releases the drug into your body over several hours

Or you could take levodopa gel, which goes straight into your intestine through a needle and a tube called duopa. It works faster than a pill because your stomach doesn't have to break down the medicine first.

A new powder form of levodopa (INBRIJA) that you breathe into your lungs and helps relieve motor fluctuations faster than a pill has also been approved .

Your doctor may suggest a second medication to boost levodopa's effects in your body or make the medicine work longer. This could help you avoid "off" time, a period when your symptoms come back.

A few drugs make your body break down levodopa more slowly so that each dose lasts longer. These include:

  • COMT inhibitors: entacapone (Comtan) and tolcapone (Tasmar)
  • MAO-B inhibitors: rasagiline (Azilect), safinamide (Xadago), selegiline (Atapryl, Carbex, Eldepryl)

Dopamine agonists like pramipexole (Mirapex) and ropinirole (Requip) act like dopamine in your brain. They can cut down on motor fluctuations, but they sometimes cause side effects like nausea, dizziness, and tiredness.

The drug apomorphine (Apokyn) is a type of dopamine agonist that acts as a "rescue" medicine. It helps bridge the gaps between levodopa doses and gives you quick relief when you get unexpected symptoms.  You inject it under your skin, similar to the insulin shots people take to treat diabetes. Apomorphine starts working in just a few minutes, and its effects last for an hour or two.

Protein helps keep your muscles and tissues strong, but it can also make your body absorb levodopa more slowly. One way to avoid this problem is to take your medicine at least 30 minutes before you eat. That will give it enough time to get absorbed. Or eat all of your protein at the end of the day.

Check with your doctor or a dietitian before you make any changes to your meal plans. They can help you adjust your protein levels safely.

A physical therapist can show you techniques that improve your balance and movement, and help you manage your motor fluctuations.

A physical therapy program can include:

  • Exercises to improve your strength and balance
  • Tips to prevent falls
  • Techniques to help you get up from a chair or bed and walk more easily
  • Advice on how to use canes or other mobility aids to help you get around safely

An occupational therapist can teach you strategies to manage motor fluctuations at work and home. You'll learn how to use tools like grabbers and long-handled shoehorns to do everyday tasks.

The therapist can also show you some changes to make to your home. For instance, you can get ideas such as adding stair rails or bathroom grab bars to prevent falls.

If medicine changes and other treatments don't stop your symptoms, surgery could be an option. Deep brain stimulation is a procedure that puts electrodes in your brain. They send out mild electrical impulses to help ease your Parkinson's symptoms.