Clinician perspectives on OFF periods in Parkinson's disease: the Spanish PARK-OFF survey-based study

The PARK-OFF study aimed to describe participating neurologists' perceptions of the impact and management of fluctuations in patients with Parkinson's disease (PD) in Spanish clinical practice.

PARK-OFF was an ecological and descriptive study based on aggregated data obtained from the experiences of 99 neurologists, collected using a 35-item survey regarding patients with PD and fluctuations seen during the previous month.

On average, 65.9 patients were seen per neurologist in the last month, and neurologists estimated that fluctuations were present in a mean of 46.1% of their patients. The most frequent duration of OFF episodes was 31 to 45 min (41.4%), and neurologists identified wearing-off as the primary contributor to daily OFF time (61.4%). According to the participants, slowness (71.6%), gait impairment (69.8%), and increased falls (67.2%) were considered to have the greatest impact on quality of life during OFF periods. The ON-OFF fluctuations were the least responsive to oral treatments, according to 76.8% of the neurologists. The speed of onset (80.8%) and ease of use (64.6%) were perceived as important factors by the participants in the prescription of an on-demand treatment. Inhaled levodopa was frequently selected as fast (90.9%) and effective (90.9%) on-demand treatment, particularly during wearing-off episodes and morning akinesia, and was associated with high satisfaction among the specialists. Neurologists identified patient education from the specialist (72.5%) as the most useful tool, in their experience, to improve patients' understanding of the disease and treatment options.

Participating neurologists perceived that fluctuations and OFF periods can impair patients' daily activities and overall well-being. On-demand treatment with inhaled levodopa was perceived by the neurologists as a useful option in the management of OFF episodes, especially those associated with wearing-off episodes and morning akinesia. Participants considered that initiation of on-demand treatments, along with improved patient education, may support the management of fluctuations in clinical practice.