Nighttime akinesia is perhaps the clinically most relevant symptom of PD patients. Nocturnal akinesia usually results from a relatively "drug free" period, as many regimens have the last dopaminergic treatment well before bedtime. Theoretically, this would mean that a "wearing off" period would occur before the next morning dose. There is some support of this observation, as some studies have reported a significant reduction in symptoms of nocturnal akinesia such as pain, spasm, and stiffness, after nocturnal dosing of a long-acting dopamine agonist such as cabergoline or sustained infusion of apomorphine through the night (33,34). Nocturnal akinesia presents as a complex of symptoms that range from difficulty in turning in bed to emergence of tremor (Table 2).
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