Why do Parkinson’s symptoms fluctuate in my 70-year-old mom?

Question

Hello doctor,

My mother, aged 70, has Parkinson’s disease. Over the past year, her tremors have worsened, and she has been experiencing episodes of stiffness and slowness that make daily tasks difficult. She is on Levodopa, but the dose adjustments seem complex.

How do you manage symptoms that fluctuate throughout the day?
When are advanced treatments considered?

Please help.

Thank you.

Answer 1

Hello,

Welcome to icliniq.com.

I have read your query and can understand your concern.

In Parkinson’s disease, it is common for symptoms like tremor, stiffness, and slowness to fluctuate during the day, especially after being on Levodopa for some time. These on-off fluctuations occur because Levodopa’s effect wears off before the next dose.

How this is usually managed:

Adjusting Levodopa timing and dose. Smaller, more frequent doses or controlled-release formulations can help maintain more stable levels.
Adding other medications. Such as MAO-B inhibitors (like Rasagiline or Selegiline), or dopamine agonists (like Pramipexole or Ropinirole), these help extend Levodopa’s effect and reduce off periods.
By making dietary adjustments. Taking Levodopa away from high-protein meals may improve absorption.

Advanced treatments are considered when symptom control becomes difficult despite optimized medications, such as:

Deep brain stimulation (DBS) is effective in reducing motor fluctuations and tremor in suitable candidates.
Levodopa-carbidopa intestinal gel (LCIG) or Apomorphine infusion, for those not suited for surgery.

A neurologist can assess her current stage, medication schedule, and suitability for advanced therapy.

Supportive therapies like physiotherapy, speech therapy, and occupational therapy also greatly improve daily function and quality of life.

I hope this answers your query.

Please let me know if I can assist you further.

Thank you.