Motor Fluctuations or "OFF" Times in Parkinson's Disease
Motor fluctuations are changes in the ability to move and are also referred to as “on-off” times. "On" is when Parkinson's medications are effective and motor and non-motor symptoms are controlled. "Off" time is when Parkinson's symptoms — motor and/or non-motor — return between medication doses. "Off" time may occur in the morning, before the first dose of medication, or during the day, between medication doses. When it happens between medication doses it may be referred to as "wearing off". "Off" time can come on gradually or suddenly and unexpectedly. These resources will help you understand how to identify your "off" time and associated symptoms, as well as share lifestyle tips and medication options to minimize "off" time.
Short Overviews
Motor Fluctuations and Parkinson's "Off" Times
Published by Parkinson's Foundation, 2021
This two-page fact sheet explains why motor and non-motor fluctuations happen, approaches your doctor may take to smooth your response to medications and minimize or avoid fluctuations, dystonia, and freezing, including medications available to treat "off" episodes.
Wearing Off and Involuntary Movements in Parkinson's
Published by Parkinson's UK, October 2022
This 12-page booklet describes the different movement problems that can happen after using levodopa for several years. It explains what might cause them and how they can be controlled, beginning with "on"/"off" periods and whether these are the same as 'freezing', what causes motor fluctuations and involuntary movements, and how you can manage them.
You Don't Have to Have OFF Times with Parkinson's
Published by Davis Phinney Foundation, June 11, 2021
"Off" times look different for everyone. Learn the four types of "off" that people with Parkinson’s experience, how to determine if you're "on" or "off", how to talk with your doctor about "on"/"off" periods, how exercise, nutrition, and GI health can help minimize "off" times, and how continuous dopaminergic stimulation can help prevent or minimize "off" times.
Talking With Your Doctor
Communicating About OFF Episodes and Dyskinesia With Your Doctor
Published by American Parkinson Disease Association, 2023
This 16-page booklet can help explain "off" time to you and your care partner and give you information to communicate with your doctor about what you are experiencing, so you can receive optimal care and maintain your best quality of life. It explains what causes "off" periods, how "off" periods can affect you throughout the day and reduce quality of life, what symptoms you may have during "off" periods and how to communicate with your doctor. Also included are treatment options.
How to Communicate What it Means to be OFF
Published by Davis Phinney Foundation, January 22, 2019
This article aims to provide people with Parkinson’s, care partners, and healthcare providers a common language to define "off" times and suggests how these interested parties can improve communication about "off" times.
Panel Discussions
Two Discussions of "Off" Time
By The Michael J. Fox Foundation, September, 2021
Parkinson’s “Off” Time: What It Looks Like, and How to Manage It
In this 42-minute podcast, experts discuss “off” periods — those times when medication can wear off between doses, or are not working optimally, and symptoms can return. This explores how people experience “off” differently and the steps you can take to manage “off” time, including how you can communicate with doctors and care partners about what you’re experiencing and ongoing research to decrease or treat these episodes.
Too Much or Not Enough: Dyskinesia and "Off" Time in Parkinson's
In this one-hour webinar, expert panelists discuss common Parkinson’s issues — “off” time and dyskinesia — and how to treat them. “Off” time is when symptoms return between medication doses. Dyskinesia is uncontrolled, involuntary movement. Speakers cover tips for managing these problems and the latest research.
Talks by Specialists
Treatment of OFF Time in Parkinson Disease
By Neurology Live, October 4, 2023
Episode three of the five-part series, "Minimizing Variations in Patient’s Experience with Levodopa Therapy in Parkinson's Disease." In this two-minute video Robert Hauser, MD, MBA, discusses when it is appropriate to consider more than carbidopa/levodopa to minimize "off" time in PD.
Links to Episode 2, "Predictability of Dyskinesia and OFF Episodes in Parkinson Disease" and Episode 4, "Amantadine Extended Release for the Management of Dyskinesia and OFF Episodes" are easily available.
Two Talks on "Off" Time
By Davis Phinney Foundation
OFF Time in Parkinson's: Your Top 20 Questions Answered
In this 55-minute 2021 webinar, movement disorders specialist Yasar Torres-Yaghi, MD, answers questions about "off" time in Parkinson's including symptoms, medications, deep brain stimulation and more.
Managing Motor Symptoms During OFF Times in Parkinson's
In 40-minute 2022 webinar, a panel including a person with Parkinson's, an occupational therapist, and a movement disorder specialist discuss how to manage motor symptoms when your medication has worn "off."
Scientific Explanation
The Science of Parkinson's OFF
Published by Davis Phinney Foundation, November 16, 2020
"Off" periods occur when your medication isn’t working optimally, and your motor and non-motor symptoms return. This article aims to help readers understand the scientific causes of "off" times to help you minimize it in your daily life. Discussed is levodopa's path through the digestive tract and through the blood-brain barrier, the role of protein, constipation, PD progression in affecting "off" times, and more.
Expert-Level Resources
Clinical Use of On-Demand Therapies for Patients with Parkinson’s Disease and OFF Periods
By Rajesh Pahwa et.al. Published in Neuropsychiatric Disease and Treatment; 23 May 2023, volume 12, pages 1033-1049
On-demand therapies (injectable apomorphine, sublingual apomorphine, and inhaled LD) for PD provide rapid relief for patients experiencing 'off' periods; however, practical guidelines on the use of these therapies are not generally available. The conclusion of this paper states, "As [these therapies] are safe and effective for 'off' periods, and due to the marked negative impact of the 'off' periods, we need to consider using them earlier when patients have motor fluctuations."
Last updated October 2025 by Stanford Parkinson's Community Outreach.