Assessment of early morning off periods in Parkinson's disease

Objectives: Early morning off (EMO) is a poorly defined symptom experienced as one of the first complications by patients with Parkinson's disease (PD). EMO periods are known to be a cause of significant disability and have a negative impact on quality of life. However, EMOs are thought to be caused by delayed on of the first daily dose of levodopa due to gastroparesis, little is known about EMOs. The purpuse of this study is to investigate EMO prevalance, demographic information and relation to gastroparesis symptoms, sleep parameters and quality of life. Materials and Methods: In this cross-sectional observational study, a questionnaire evaluated EMOs, gastroparesis symptoms, sleep parameters and non-motor sypmtoms was administered to 90 patients with idiopathic PD attending a routine appointment. Patients' disease severity was evaluated by Hoehn&Yahr scale and quality of life was evaluated by The Short Form Parkinson's Disease Questionnaire (PDQ-8). Results: EMO periods are common across all disease stages and occur in 42.2 % of all patients. EMOs were found to be associated with gastroparesis symptoms (p<0.05). While EMO patients with emo patients suffer from an average of 3 gastroparesis symptoms, patients without EMO only have an avarege of 1 gastroparesis symptoms. The most common symptoms while EMO were difficulty with getting out of the bed/turning in the bed and fatigue. The prevalence of EMO increased as nighttime sleep duration reduced and wake after sleep onset increased (p<0.001).Also, the quality of life (QOL) of those with EMO was significantly reduced (p<0.001). Conclusions: The prevalence of EMO across all motor stages is significantly high and it is lowering QOL. It is observed there is a significant relation between gastroparesis symptoms and EMO. Questioning EMO with gastroparesis symptoms and developing better management and treatment strategies for this group of patients with PD is needed. Keywords: Early morning off, morning akinesia, gastroparesis symptoms, sleep, quality of life