Good morning, Mr Smith how are you feeling today?

Oh I am good. Nurse notices twitching in his legs and arms.

I noticed that you're twitching a bit. How long have you been experiencing this twitching?

It's been going on for a few months now, but I just assumed it was my Parkinson's getting worse.

I see. The twitching you're experiencing is actually a symptom of dyskinesia, which can develop as a result of long-term use of levodopa, one of the medications you take for Parkinson's.

Are you aware of the On and OFF patterns of Dyskinesia ?

In the context of Parkinson's disease, the term "on" dyskinesia refers to the movements that occur when the levodopa is working effectively and the patient is experiencing the desired therapeutic effects of the medication.

"Off" dyskinesia refers to the movements that occur when the levodopa is not working effectively, usually because the patient has gone too long between doses or the medication has worn off. During these "off" periods, patients may experience spasms or cramps that can be painful and disruptive.

Oh i have been experiencing cramps lately as well. But i take all my medications on time? should i take a higher dose of medication ? or should i stop taking them if they are the ones causing it ?

Well, it's always important to speak with your healthcare provider before making any changes to your medication regimen. I can communicate with your doctor and set up an appointment for you to discuss your options.

In the meantime, it can be helpful to log your dyskinesia in relation to your "on" and "off" periods. I know that you live alone, have you thought of installing camera ? the recording can help us measure the severity and frequency of your episodes.

i can help you pick up a budget friendly option and help set it up for you.

Perfect. Our goal is to help you manage your dyskinesia and improve your quality of life. I'll be in touch with your doctor and we'll work together to find the best solution for you.

Can you tell me a little more about how it's affecting you?

Well, it's pretty disruptive and can be painful at times. It also makes it hard for me to do everyday activities.

I understand. It can be helpful to have a better understanding of the severity and impact of the dyskinesia. That's why I'd like to administer the Unified Dyskinesia Rating Scale, which will give us a better idea of the impact of your dyskinesia and help track any changes over time.

If levo is causing the twiticing then i am going to stop taking them.

Can you tell me a little more about how the dyskinesia is affecting you?

Oh, it happens time to time. I just thought my Parkinsons was getting worse. is there anything you can do ?

I am afraid i cant do much as a nurse. I can set up an appointment with you doctor and you can tell them about your issues.