Clinical approach to nonmotor sensory fluctuations in Parkinson's disease

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.

Recognition of NMSFs is important in the care of patients with Parkinson disease to prevent unnecessary interventions and for appropriate medication regimen adjustments.