EP 23 - Papers on 'Response Fluctuations'

March 12, 2026

🎙️ We’re back with the twenty third episode of Parkinson Weekly, hosted by Prof. Bas Bloem.In Episode 23 of Parkinson Weekly, Prof. Bas Bloem explores the phenomenon of response fluctuations, where the benefits and side effects of oral Parkinson’s medications vary throughout the day. Rather than focusing on a single new study, this episode revisits several influential papers that have reshaped how clinicians understand these fluctuations and their underlying mechanisms.Listeners will learn about key concepts including “on” and “off” states, predictable wearing-off, dose failures, and different types of dyskinesias—including peak-dose and biphasic dyskinesias. The episode also highlights how Parkinson’s disease progression narrows the brain’s therapeutic window, making it increasingly difficult to maintain stable symptom control.Prof. Bloem also discusses an often overlooked factor: the gut. Gastrointestinal issues such as delayed gastric emptying, constipation, small intestinal bacterial overgrowth (SIBO), and Helicobacter pylori infection can significantly affect how levodopa is absorbed, leading to delayed or unpredictable medication responses.Finally, the episode explores treatment strategies—from adjusting dosing schedules and adding adjunct medications to the role and limitations of continuous dopaminergic therapies, while emphasising the importance of realistic treatment goals and expectation management.This episode offers practical insights for clinicians, people living with Parkinson’s disease, and caregivers seeking to better understand and manage medication fluctuations.Listen now to discover how evolving research is shaping the way we approach response fluctuations in Parkinson’s disease.Articles mentioned can be found here:https://www.thelancet.com/journals/laneur/article/PIIS1474-4422(15)00007-1/abstracthttps://movementdisorders.onlinelibrary.wiley.com/doi/10.1002/mds.870120304https://pmc.ncbi.nlm.nih.gov/articles/PMC2865731/Have a question you’d like Bas to answer in a future episode? Email us at parkinsonweekly@gmail.com – we’d love to hear from you.