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We studied the nature and frequency of nonmotor"off"phenomena in 130 consecutive patients with Parkinson's disease(PD)with motor fluctuations. Twenty-two patients(17%)experienced nonmotor fluctuations as an end-of- dose phenomenon.Previously unreported,or little appreciated,nonmotor"off" states include sensory dyspnea,nausea,facial flushing,cough,hunger, unilateral limb edema,proximal limb pain and trigeminal neuralgia-like pain.We attempted treatment modification in 12 of 22 patients;nonmotor" off"symptoms improved in nine of these 12 patients(75%).Recognizing these phenomena will prevent unnecessary tests and treatment. |
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