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In patients with Parkinson’s disease (PD), motor and non-motor symptoms are frequent during OFF periods, especially when the next levodopa dose has a delayed onset of action (delayed ON). Delayed ON of the first daily dose of levodopa is known as morning akinesia, which can significantly affect quality of life and impair daily activities. Morning akinesia can occur due to a delay in gastric emptying, impaired intestinal absorption, pharmacodynamic effects or other mechanisms. Gastroparesis is common in patients with PD and can cause gastrointestinal symptoms, delayed ON and morning akinesia. Alternative delivery of dopaminergic therapy by a non-oral route may be useful in patients with PD and gastroparesis. Subcutaneous apomorphine injection is used by patients with PD in the OFF state to decrease time-to-ON. An ongoing study is investigating its use for morning akinesia, as well as the frequency of delayed gastric emptying in these patients.

european neurological review

Morning Akinesia and the Potential Role of Gastroparesis – Managing Delayed Onset of First Daily Dose of Oral Levodopa in Patients with Parkinson’s Disease