Can you share a person you have managed who has experienced increased “off time” and motor fluctuations with CD/LD who might be an ideal patient for treatment with titratable formulations, including those based on scored, fractionable doses of CD/LD?
Patients with early treatment in Parkinson's disease. Typically as I mentioned, start on cinematic or car would open leave it open 25 103 times per day is a classic dosing regimen and patients may initially have the honeymoon phase where they're smooth and don't notice any wearing off. But over time they start noticing that their symptoms return. And the way you recognize that between doses is that patients will have tremor, a resting tremor return before the next dose is due rigidity and slowness. But not only do you have motor symptoms as these, you may also have non motor symptoms such as anxiety, a feeling of fogginess and cognition. Different non motor symptoms can herald the onset of off as well. And so you have both motor and non motor symptoms of off in these patients and so it can be quite difficult for patients to verbalize initially what they're going through. I remember anecdotally in my practice, I had a patient that said, you know, I just don't feel good at some parts of the day. I asked her, I said, well ma'am, what do you think is going on? And what is the timing of your medication? She didn't correlate the two between off and feeling poorly, but I brought her in and observed her through a whole cycle of dusting of levodopa and what I noticed was when I watched her over four hours or so. She took her medication initially and had a nice improvement of her trimmer and slowness and her brady keynesian was better and her stiffness was better testing her tone. But I also followed her as she wore off and what had returned well, tremor slowness, all these cardinal features of Parkinson's disease had returned in her, and she didn't correlate that with wearing off. But a lot of patients and clinicians may not be aware of what off is or how to detect it, But if you ask your patients about off, every time they come in, you'll pick up a lot more because sometimes they won't volunteer it.
