The On/Off Cycle

When people start to take medication for their Parkinson’s disease, they usually notice that their symptoms go away for hours at a time (ON times), then return (OFF times.) Symptoms also return during the wearing off period, when Parkinson’s treatments become less effective.

Moving back and forth between ON and OFF times is a reality for Parkinson’s disease patients. ON times can also be accompanied by side effects called dyskinesias — sudden jerky or uncontrolled movements of the limbs and neck.

Adjusting to medication: ON and OFF cycles
Perhaps the biggest adjustment Parkinson’s disease patients will have to make is learning to live with the "ON-OFF” cycle. This is the back and forth between periods of time with symptoms and periods of time without symptoms. It fast becomes the PD patient’s new rhythm of life.

During ON times, patients report they feel relatively fluid, clear, and in control of their movements. Often, symptoms of PD may be invisible to all but professionals.

During OFF periods, patients experience stiffness, lack of muscular coordination, pain, difficult handwriting — the full range of classic PD symptoms. Most patients have visible symptoms. Typically, patients will cycle between ON and OFF periods three to four times every day, although everyone’s experience is unique.

Signals that OFF times are coming
Often there are warning signs that OFF time is approaching. These can include things such as handwriting problems, overall slowness, loss of sense of smell, stiffness in muscles, and other warning signs.

PD patients will find it beneficial to arrange life around ON and OFF rhythms. In consultation with their doctors, patients can learn to adjust their medication so that it becomes effective when they want it to be.