Novel pattern of levodopa-related motor fluctuations: 'paradoxical'on

Generally, motor functions of Parkinson disease (PD) patients become worse as levodopa wears off. Recently, we encountered four PD patients who reported that their motor functions get better after levodopa wears off. These patients were admitted and the pattern of motor fluctuations was monitored. All showed a novel pattern where motor function spontaneously got better near to on level without medication after the effect of levodopa wore off. We call this 'paradoxical'on because motor functions get paradoxically better when levodopa is most likely washed out from the body. Pathomechanism of 'paradoxical'on is uncertain and needs further investigation.