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

J Clin Psychiatry. 2020 Oct 27;81(6):SU19004BR1C. doi: 10.4088/JCP.SU19004BR1C.


​​​​ 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.

Publication types

  • Research Support, Non-U.S. Gov't
  • Review

MeSH terms

  • Antiparkinson Agents / pharmacology*
  • Cost of Illness*
  • Disease Progression*
  • Humans
  • Levodopa / pharmacology*
  • Parkinson Disease* / diagnosis
  • Parkinson Disease* / drug therapy
  • Parkinson Disease* / physiopathology
  • Physician-Patient Relations*
  • Quality of Life


  • Antiparkinson Agents
  • Levodopa