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Pathophysiology, Patient Burden, and Recognition of OFF Episodes of Parkinson Disease

Rajesh Pahwa, MD, and Stuart H. Isaacson, MD

Published: October 27, 2020

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Find more articles on this and other psychiatry and CNS topics:
The Journal of Clinical Psychiatry
The Primary Care Companion for CNS Disorders


The pathophysiology of PD has been elusive, but the motor symptoms of the disease are believed to result from a dopamine deficiency in the substantia nigra. As a patient’s disease progresses, OFF episodes emerge due to a shorter duration of response to levodopa treatment. OFF episodes include both motor and nonmotor symptoms, are common, and can occur at any time. OFF episodes can be predictable or unpredictable, significantly impact patient quality of life and functionality, and place a burden on families. By facilitating communication with patients and care partners using assessment tools, clinicians can detect symptoms of OFF episodes earlier.

From the University of Kansas, Kansas City (Dr Pahwa); and Parkinson’s Disease and Movement Disorders Center of Boca Raton, Florida (Dr Isaacson)

To cite: Isaacson S, Pahwa R. Pathophysiology, patient burden, and recognition of OFF episodes of Parkinson disease. J Clin Psychiatry. 2020;81(6):SU19004BR1C.

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© Copyright 2020 Physicians Postgraduate Press, Inc.

Volume: 81

Quick Links: Neurologic and Neurocognitive , Parkinson Disease


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