Spontaneous wriggling or writhing movements which can occur when the medicine is working (i.e. the patient is 'on').
A rhythmic, oscillating movement, most commonly of the hands and or limbs.
When the patient is adequately treated and movements are reasonably fluent and spontaneous.
When when the patient's medication has worn off and movements are slow, deliberate and difficult. Other less visible symptoms of pain and distress may be a feature for some patients.
A noticeable transition from 'on' to 'off' occurring between doses of medication.
An umbrella term for the motor complications of more 'brittle' advanced disease. Patients can fluctuate from 'off', to 'on' and "on with dyskinesia." The change may be gradual or a sudden switch.

For Clinicians

Parkinson's Disease


What is Parkinson's Disease?

Care of the Dying Pathway

Inpatient Care

Non Motor Symptoms

PD Care - Top 12 Tips

PD & Surgical Admissions

The first 24 hours

Medications & NBM Guidelines

Help us track our patients

Other web resources

Criteria for Urgent Review

Parkinson's Service - Contacts

What is Parkinson's Disease?

PD is a neuro-degenerative condition.

It progresses slowly over years.

The outward signs are due to a lack of dopamine in the cells of the basal ganglia – the movement control centre deep in the brain.

This causes stiff, slow movements, and often tremor. Gait may be difficult to start – or patients may "freeze" in doorways or when trying to turn

People depend on medication to counteract the lack of dopamine.

In the early stages of the illness, neurones can store dopamine and "buffer" any variations in drug blood levels. The medicine response is fairly constant, even if doses are late.

"On/Off" fluctuations develop when this "buffer" mechanism starts to fail.

The medicine response may 'wear off' if blood levels fall. Medication timing is crucial.

In more advanced "On/Off" fluctuations, dyskinesia may occur when the medication is working (i.e. when 'on'). Patients generally prefer to be 'on' with dyskinesia than 'off' but seek advice if persistent or severe.

Other nerve cells are affected, and other neurotransmitters too, and so PD is much more than a movement disorder.

Parkinson's Disease patients are vulnerable in hospital:

  • Medication gets missed
  • Mobility and stiffness gets worse in bed or without normal medicines
  • Swallow function declines
  • Nutrition at risk from poor hand dexterity and swallow
  • Communication takes time
  • Delirium is common

Call for help if your patient with PD is getting worse.

The majority of patients with early PD can do well in hospital if they are given their medication and can swallow it - make sure they get it!

Zero tolerance for pharmacy code 4 in Parkinson's patients!

Parkinson's Disease on NHS.uk

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