The wearing-off phenomenon in Parkinson's disease refers to the recurrence of motor and non-motor symptoms before the next scheduled dose of levodopa.

Patient selection: Parkinson's disease on levodopa therapy


Risk factors for wearing-off phenomenon:

(1) earlier age at the onset of Parkinson's disease (age < 60 years)

(2) longer disease duration (7.9 years +/- 5.1 vs 5.6 +/- 3.1)

(3) longer duration of therapy with anti-Parkinsonian therapy (7.2 years +/- 5.1 vs 3.9 +/- 3.5)

(4) longer duration on levodopa treatment (6.9 +/- 4.9 vs 3.1 +/- 2.8)


It is important to exclude other explanations for the symptoms such as cerebrovascular disease or drug effect.


If the wearing-off phenomenon is identified then therapy is modified, which may involve:

(1) more frequent dosing of levodopa

(2) sustained release formulation

(3) addition of another agent

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