Clinical features and varieties of non-motor fluctuations in Parkinson's disease: A Japanese multicenter study

Morinobu Seki, Kazushi Takahashi, Daisuke Uematsu, Ban Mihara, Yoko Morita, Kazuo Isozumi, Kouichi Ohta, Kazuhiro Muramatsu, Toshitaka Shirai, Shigeru Nogawa, Jun Gotoh, Keiji Yamaguchi, Yutaka Tomita, Daisuke Yasutomi, Yoshihiro Nihei, Satoko Iwasawa, Norihiro Suzuki

Research output: Contribution to journalArticlepeer-review

49 Citations (Scopus)


Objective: This multicenter cross-sectional study aimed to investigate the clinical features and varieties of non-motor fluctuation in Parkinson's disease (PD). Methods: To identify motor and non-motor fluctuation, we employed the wearing-off questionnaire of 19 symptoms (WOQ-19) in 464 PD patients. We compared the frequency of levodopa-related fluctuation as identified by the WOQ-19 with recognition by neurologists. We compared patients with both motor and non-motor fluctuations with those who only had motor fluctuations. Non-motor fluctuations were separated into psychiatric, autonomic, and sensory categories for further analysis. Results: The patients' average age was 70.8 ± 8.4 years (mean ± SD) and disease duration was 6.6 ± 5.0 years. The frequency of motor fluctuations was 69% and for non-motor fluctuation 40%. Fifty-three percent of patients with motor fluctuations also had non-motor fluctuations, whereas 93% of patients with non-motor fluctuations also had motor fluctuations. The WOQ-19 showed a sensitivity of 82% but a specificity of only 40%. The patients with both non-motor and motor fluctuations exhibited more severe motor symptoms, more non-motor symptoms and higher levodopa daily doses (p < 0.05). Patients had significantly higher fluctuation rates if they had psychiatric (49%) and sensory (45%) symptoms than patients with autonomic symptoms (32%, p < 0.01). Forty-eight percent of patients with non-motor fluctuations exhibited more than one type of non-motor fluctuation. Conclusion: Forty percent of PD patients presented with non-motor fluctuations, and almost half of these exhibited more than one type. Appropriate recognition of levodopa-related fluctuations, both motor and non-motor, can lead to treatment modifications in PD patients.

Original languageEnglish
Pages (from-to)104-108
Number of pages5
JournalParkinsonism and Related Disorders
Issue number1
Publication statusPublished - 2013 Jan


  • Japanese patients
  • Non-motor fluctuations
  • Non-motor symptoms
  • Parkinson's disease
  • Wearing-off

ASJC Scopus subject areas

  • Neurology
  • Geriatrics and Gerontology
  • Clinical Neurology


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