Morning akinesia is a condition that prohibits a person from being able to move their muscles when they first wake up in the morning. It occurs due to a period without treatment of the underlying cause during the night, which results in low levels of dopamine.
The term akinesia means absent movement. Akinesia is a condition that temporarily stops a person from being able to move unaided. A person may feel rigidity in their muscles as if they are in a frozen-like state.
Morning akinesia takes place when a person first wakes up in the morning. This is due to there having been an extended period since last taking the medication that helps prevent their disease symptoms. It typically affects a person who has a neurological disorder, such as Parkinson’s disease (PD).
In this article, we will discuss what morning akinesia is and how it relates to conditions such as Parkinson’s disease.
What is morning akinesia?
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Morning akinesia is a neurological disease symptom that can occur first thing in the morning when a person wakes. It affects approximately 6 in 10 people receiving dopamine-related medication.
Early morning off (EMO) time describes a time in the morning when a person experiences a reoccurrence of disease symptoms after a nightlong period without treatment. EMO may also occur if their medication starts to wear off prematurely.
A person may also experience a delayed onset of the benefits of their morning dose of medication, known as delayed ON. Delayed ON can last twice as long as EMO.
Morning akinesia defines the period of delayed ON when a person experiences a reoccurrence of disease symptoms, including muscle rigidity. A person typically finds they cannot move their muscles unaided.
Why does it occur?
Neurological conditions such as Parkinson’s disease typically occur when a person has low levels of dopamine in the brain. Morning akinesia is a common motor complication of the disease, although not everyone with morning akinesia has Parkinson’s disease.
Levodopa (L-dopa) is one of the most effective medications that doctors prescribe to treat severe motor symptoms of Parkinson’s disease. L-dopa works as a dopamine replacement agent and increases dopamine levels.
A person typically takes a final dose of L-dopa medication before going to bed. Morning akinesia occurs first thing in the morning when a person has had a treatment-free night and levels of dopamine have become low.
Additionally, L-dopa medication can sometimes have a delayed onset, which means L-dopa levels can take a while to rise after the morning dose of medication.
Other possible symptoms of EMO
Alongside muscle rigidity and difficulty moving unaided, there are several other symptoms a person with morning akinesia may experience during EMO. These include:
- excessive sweating
- excessive salivation
- muscle cramps
- fatigue or sleepiness
- muscle tremors
- freezing of gait
- bradykinesia — slowness of movement
- anxiety
- urgent need to urinate
- pain
- low mood
- limb paresthesia
- dizziness
How to manage symptoms
There are a number of ways a person can manage the symptoms of morning akinesia, including:
- Medications: The Food and Drug Administration (FDA) approved Nourianz (istradefylline) as an add on to L-dopa to help treat morning akinesia. It works by boosting levels of dopamine in the brain. Medications such as catechol-O-methyltransferase (COMT) inhibitors and monoamine oxidase Inhibitors (MAOI) can extend the benefits of a L-dopa dose as they allow more L-dopa to reach the brain.
- Avoiding high-protein meals: The body absorbs protein in the same part of the intestine as L-dopa medication. This can result in the body absorbing less medication while it is digesting food. Therefore, a person should avoid taking L-dopa with high-protein meals.
- Liquid L-dopa: Administering L-dopa as a liquid solution can help the medication absorb into the small intestine more quickly and, therefore, may improve the onset of effect, although more research is necessary to confirm this.
- Progressive resistance training (PRT): PRT is a type of strength training that can help to improve symptoms of Parkinson’s disease that link to morning akinesia.
- Surgical therapy: A surgical procedure that can help manage morning akinesia is deep brain stimulation, which can lead to increased dopamine production.
- Further procedures: In severe cases of morning akinesia, a doctor may recommend brain procedures such as a thalamotomy, pallidotomy, and neural implants.
Summary
Morning akinesia refers to a period of time in the morning when a person experiences a reoccurrence of muscle rigidity. This is due to a delay in the onset of L-dopa medication benefits or a prolonged period since taking the previous dose.
It is a common motor complication of Parkinson’s disease and can affect approximately 6 in 10 people taking dopamine-related medication.
A person can help to manage the symptoms of morning akinesia by using certain additional medications, adjusting their diet and exercise regimen, or undergoing a surgical procedure.
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