My husband has had Parkinson’s disease for about six years. He doesn’t have any tremors, but he is stiff and slow, and sometimes ‘freezes’. He finds that some days are worse than others, even though he is taking his medication as usual and isn’t doing anything particularly strenuous. Can the condition fluctuate like this, and is there anything that can be done about it?

These symptoms could indicate ‘dose gaps’, i.e. insufficient effects from individual doses. You should pay attention to when symptoms occur and how they are affected by individual doses of anti-Parkinson’s medication. If there is some relief from the symptoms some time after taking a tablet, usually within 30–60 minutes, and if the symptoms return some time later, again approximately 30–60 minutes later, this may indicate a ‘dose gap’. If you have access to T Madopark Quick Mite 50 mg, or ½ tablet of Madopark 100 mg (levodopa/benserazide) or ½ tablet of Sinement 25/100 (carbidopa/levodopa 25/100), you can take some of it when a dose gap occurs. If the symptoms improve significantly, and on repeated occasions, it is very likely that this is due to a dose gap. The basic medication will then need to be adjusted. If the medication has remained more or less unchanged over the last few years, the doses may need to be adjusted, as the disease has progressed, and it may be necessary to increase the doses to compensate for this./Håkan Widner