Medical Crossfire®: Managing Motor Fluctuations and Dyskinesia in Parkinson's Disease: Turning the "Off" Switch "On"

Released On
November 30, 2018

Expires On
November 30, 2019

Media Type

Completion Time
90 minutes


Parkinson's Disease

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This activity is provided by Physicians' Education Resource®, LLC.


Supported by an educational grant from Acorda Therapeutics, Inc. and Neurocrine Biosciences, Inc.

Credit Available

  • Physicians — maximum of 1.5 AMA PRA Category 1 Credit(s)
  • Nurses — 1.5 contact hours

All other health care professionals completing this course will be issued a statement of participation.

Target Audience

This continuing medical education (CME) activity is intended for neurologists, nurse practitioners (NPs), physician assistants (PAs), and other health care professionals involved in the treatment and management of patients with PD.

Program Overview

Parkinson's disease (PD) is the second most common neurogenerative disease after Alzheimer’s disease, affecting approximately 1 million people in the United States. The progression of PD and degree of impairment vary by individual and include impaired motor function, bradykinesia, tremor, gait and balance disturbances, and nonmotor symptoms such as sleep disorders, neuropsychiatric disturbances, gastrointestinal symptoms, and sensory deficits. The gold standard for management of motor symptoms is levodopa, the metabolic precursor of dopamine. However, levodopa has a short half-life and is poorly absorbed by some patients, leading to motor fluctuations and dyskinesia in long-term treatment of patients with PD. Approximately 10% of patients per year develop motor fluctuations after initiating levodopa, and 50% of patients with PD will develop these complications after 5 years of treatment. Dyskinesia typically follows motor fluctuations and is commonly associated with levodopa. The time when pharmacologic therapies are providing patient benefits in treating PD motor symptoms is referred to as “on” time. Conversely, the time when these therapies are not providing motor benefits is referred to as “off” time. Adequate management of off time remains one of the major unmet needs of PD management, and emerging treatments can provide effective and convenient relief.

During this Medical Crossfire®, a panel of expert faculty will review evidence-based therapeutic options for the management of motor fluctuations and dyskinesia in PD and discuss new and emerging levodopa and non-levodopa-based therapies. The panel will also discuss the importance of developing a patient-centered approach to care and strategies to effectively engage a multidisciplinary team to improve the management of PD motor fluctuations during off periods.

Learning Objectives

Upon completion of this activity, participants should be able to:

  • Review evidence-based pharmacologic treatment options for management of motor fluctuations and dyskinesia in PD.
  • Review new and emerging treatments for motor fluctuations and dyskinesia in PD.
  • Discuss ways to add midlevel providers to the PD treatment team.


Paul P. Doghramji, MD, FAAFP

Family Physician, Collegeville Family Practice
Medical Director, Health Services, Ursinus College
Collegeville, Pennsylvania

Peter A. LeWitt, MD

Director Parkinson Disease and Movement Disorder Program
Henry Ford Hospital
West Bloomfield, Michigan

Corneliu Luca, MD

Associate Professor of Neurology
University of Miami
Miami, Florida

Cathi A. Thomas, MS, RN, CNRN

Assistant Clinical Professor of Neurology
Program Director, Parkinson Disease and Movement Disorders Center
Boston University Medical Campus
Boston, Massachusetts

Accreditation Statement

Physicians’ Education Resource®, LLC, is accredited by the Accreditation Council for Continuing Medical Education (ACCME) to provide continuing medical education for physicians and is a provider approved by the California Board of Registered Nursing (CBRN).

Credit Designation Statement

Physicians’ Education Resource®, LLC, designates this enduring material for a maximum of 1.5 AMA PRA Category 1 Credit(s)™ and for 1.5 contact hours for nurses. Physicians should claim only the credit commensurate with the extent of their participation in the activity.

Disclosures of Conflicts of Interest

The following contributors have relevant financial relationships with commercial interests to disclose:

Paul P. Doghramji, MD, FAAFP

  • No financial information to disclose

Peter A. LeWitt, MD

  • Grant/research support: Acorda Therapeutics, Adamas, Biotie Therapies, Lundbeck, The Michael J. Fox Foundation for Parkinson’s Research, Parkinson Study Group, Pharma Two B, Revance, Roche, Sunovion, US WorldMeds
  • Consultant: Abide Therapeutics, Acorda Therapeutics, Biogen, Britannia Pharmaceuticals, Cavion, Denali Therapeutics; Intec Pharma, Jazz Pharmaceuticals, Lundbeck, Neurocrine Biosciences, NeuroDerm, Prexton Therapeutics, Revance, Sage Therapeutics, SynAgile, Titan Pharmaceuticals, US WorldMeds
  • Other support: annual stipend as editor-in-chief of Clinical Neuropharmacology

Corneliu Luca, MD

  • Grant/research support: Medtronic, National Institutes of Health, Parkinson’s Foundation
  • Consultant: Abbott, Abbvie, Medtronic

Cathi A. Thomas, MS, RN, CNRN

  • Consultant: Acorda Therapeutics, Allied Health Professionals Medical Advisory Board meeting, Delsys

Method of Participation

There are no fees to participate in the activity. Participants must review all activity information, including the learning objectives, disclosure statements, and content. To receive credit for participation, participants must complete the post-test (achieving a passing grade) and program evaluation. Certificates can be printed immediately.

Course Viewing Requirements

Supported Browsers:
Internet Explorer 8.0+ for Windows 2003, Vista, XP, Windows 7, Windows 8.1 and above
Google Chrome 28.0+ for Windows, Mac OS, or Linux
Mozilla Firefox 23.0+ for Windows, Mac OS, or Linux
Safari 6.0+ for Mac OSX 10.7 and above

Supported Phones & Tablets:
Android 4.0.3 and above
iPhone/iPad with iOS 6.1 or above.

Disclaimer/Disclosure of Unlabeled Use

This activity may or may not discuss investigational, unapproved, or off-label uses of drugs. Participants are advised to consult prescribing information for any products discussed. The information provided in this CME activity is for continuing medical education purposes only and is not meant to substitute for the independent medical judgment of a physician relative to the diagnostic, treatment, and management options for a specific patient’s medical condition.

The opinions expressed in the content are solely those of the individual faculty members and do not reflect those of Physicians’ Education Resource®, LLC, or any of the companies that provided commercial support for this activity.