Nocturnal akinesia is usually caused by nighttime wearing off, and strategies promoting overnight dopaminergic stimulation may be helpful. Sustained-release lev-odopa/benserazide significantly (P < 0.016) improved ability to turn in bed and total time awake (decreased from 2.13 to 0.67 hours, P = 0.046) in a 12-month open-label, noncomparative trial of 15 PD patients with distressing nocturnal symptoms (83). Open-label comparative observational reports in PD patients with severe sleep disruption due to nocturnal motor symptoms suggest that cabergoline, a long-acting once a day dopamine agonist, may be superior to levodopa or pergolide (84,85,95). Overnight apomorphine infusion also has been reported to be beneficial for nocturnal motor and nonmotor symptoms of PD (86). Studies are investigating the efficacy of prolonged release formulations of agents such as ropinirole and the rotigotine transdermal patch on nocturnal akinesia.
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