“ASK THE DOCTOR” with Dr. Rebecca Gilbert
Q. My husband experiences big differences in the time it takes for a dose of carbidopa/levodopa to work. It may take anywhere from 20 minutes to 2.5 hours! That makes it very difficult to know when to take the medication when we are going out.
A. This problem can be so frustrating. The unpredictable ONs and OFFs that your husband is experiencing can be due to many things, including (1) unpredictable gastric motility — it could be that the pills get “hung up” in the stomach because the gut is not moving properly, or (2) other GI pathology which may interfere with levodopa absorption. I would talk to your neurologist about this issue and perhaps ask for a consult with a gastroenterologist to see if there is anything that can be done to help with more predictable levodopa absorption. If your doctors can’t pinpoint a reason for the erratic nature of your husband’s responses to medications, then speak with the neurologist about potentially adding an as-needed medication to his regimen that he can take if his regular dose is not effective.
Q. I have PD, and when I have no stress, I can walk. But if I am under stress, my feet stick to the ground when I try to walk. What can I do?
A. You are describing a clinical phenomenon known as freezing of gait, in which a person tends to take multiple stutter-steps in place before being able to move their stride forward. There are various potential causes for this, and you should speak to your doctor because adjusting your PD medications might make a difference. There are also quite a few tips and tricks to help you get “unstuck.” For example, try another movement — raise an arm, touch your head, point to the ceiling, and then restart — or change direction. If you can’t move forward, try stepping sideways first, and then go forward. For a more in-depth look at freezing of gait and more tips, you can take a look at this blog post, and also visit apdaparkinson.org.
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Dr. Rebecca Gilbert is the Chief Scientific Officer at APDA. She oversees APDA’s research portfolio in conjunction with APDA’s Scientific Advisory Board. She also provides medical and clinical expertise to support APDA programming as well as print and web content.