Frontiers in neurology · 2026
Clinician perspectives on OFF periods in Parkinson's disease: the Spanish PARK-OFF survey-based study.
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Ruiz-Martínez Javier, Rezola Elisabet Mondragón, Aragón Ana Vinagre, Vilella Lara Pardina, Marcos María Sofía Cámara, Caballero David Campo, PARK-OFF Study group
Аннотация
PURPOSE: The PARK-OFF study aimed to describe participating neurologists' perceptions of the impact and management of fluctuations in patients with Parkinson's disease (PD) in Spanish clinical practice.
METHODS: PARK-OFF was an ecological and descriptive study based on aggregated data obtained from the experiences of 99 neurologists, collected using a 35-item survey regarding patients with PD and fluctuations seen during the previous month.
RESULTS: On average, 65.9 patients were seen per neurologist in the last month, and neurologists estimated that fluctuations were present in a mean of 46.1% of their patients. The most frequent duration of OFF episodes was 31 to 45 min (41.4%), and neurologists identified wearing-off as the primary contributor to daily OFF time (61.4%). According to the participants, slowness (71.6%), gait impairment (69.8%), and increased falls (67.2%) were considered to have the greatest impact on quality of life during OFF periods. The ON-OFF fluctuations were the least responsive to oral treatments, according to 76.8% of the neurologists. The speed of onset (80.8%) and ease of use (64.6%) were perceived as important factors by the participants in the prescription of an on-demand treatment. Inhaled levodopa was frequently selected as fast (90.9%) and effective (90.9%) on-demand treatment, particularly during wearing-off episodes and morning akinesia, and was associated with high satisfaction among the specialists. Neurologists identified patient education from the specialist (72.5%) as the most useful tool, in their experience, to improve patients' understanding of the disease and treatment options.
CONCLUSION: Participating neurologists perceived that fluctuations and OFF periods can impair patients' daily activities and overall well-being. On-demand treatment with inhaled levodopa was perceived by the neurologists as a useful option in the management of OFF episodes, especially those associated with wearing-off episodes and morning akinesia. Participants considered that initiation of on-demand treatments, along with improved patient education, may support the management of fluctuations in clinical practice.
METHODS: PARK-OFF was an ecological and descriptive study based on aggregated data obtained from the experiences of 99 neurologists, collected using a 35-item survey regarding patients with PD and fluctuations seen during the previous month.
RESULTS: On average, 65.9 patients were seen per neurologist in the last month, and neurologists estimated that fluctuations were present in a mean of 46.1% of their patients. The most frequent duration of OFF episodes was 31 to 45 min (41.4%), and neurologists identified wearing-off as the primary contributor to daily OFF time (61.4%). According to the participants, slowness (71.6%), gait impairment (69.8%), and increased falls (67.2%) were considered to have the greatest impact on quality of life during OFF periods. The ON-OFF fluctuations were the least responsive to oral treatments, according to 76.8% of the neurologists. The speed of onset (80.8%) and ease of use (64.6%) were perceived as important factors by the participants in the prescription of an on-demand treatment. Inhaled levodopa was frequently selected as fast (90.9%) and effective (90.9%) on-demand treatment, particularly during wearing-off episodes and morning akinesia, and was associated with high satisfaction among the specialists. Neurologists identified patient education from the specialist (72.5%) as the most useful tool, in their experience, to improve patients' understanding of the disease and treatment options.
CONCLUSION: Participating neurologists perceived that fluctuations and OFF periods can impair patients' daily activities and overall well-being. On-demand treatment with inhaled levodopa was perceived by the neurologists as a useful option in the management of OFF episodes, especially those associated with wearing-off episodes and morning akinesia. Participants considered that initiation of on-demand treatments, along with improved patient education, may support the management of fluctuations in clinical practice.