{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,9,14]],"date-time":"2026-09-14T05:04:24Z","timestamp":1789362264922,"version":"build-2803163510"},"reference-count":33,"publisher":"Frontiers Media SA","license":[{"start":{"date-parts":[[2026,9,14]],"date-time":"2026-09-14T00:00:00Z","timestamp":1789344000000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"content-domain":{"domain":["frontiersin.org"],"crossmark-restriction":true},"short-container-title":["Front. Neurol."],"abstract":"<jats:sec>\n                    <jats:title>Purpose<\/jats:title>\n                    <jats:p>The PARK-OFF study aimed to describe participating neurologists\u2019 perceptions of the impact and management of fluctuations in patients with Parkinson\u2019s disease (PD) in Spanish clinical practice.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Methods<\/jats:title>\n                    <jats:p>PARK-OFF was an ecological and descriptive study based on aggregated data obtained from the experiences of 99 neurologists, collected using a 35-item survey regarding patients with PD and fluctuations seen during the previous month.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Results<\/jats:title>\n                    <jats:p>On average, 65.9 patients were seen per neurologist in the last month, and neurologists estimated that fluctuations were present in a mean of 46.1% of their patients. The most frequent duration of OFF episodes was 31 to 45\u202fmin (41.4%), and neurologists identified wearing-off as the primary contributor to daily OFF time (61.4%). According to the participants, slowness (71.6%), gait impairment (69.8%), and increased falls (67.2%) were considered to have the greatest impact on quality of life during OFF periods. The ON\u2013OFF fluctuations were the least responsive to oral treatments, according to 76.8% of the neurologists. The speed of onset (80.8%) and ease of use (64.6%) were perceived as important factors by the participants in the prescription of an on-demand treatment. Inhaled levodopa was frequently selected as fast (90.9%) and effective (90.9%) on-demand treatment, particularly during wearing-off episodes and morning akinesia, and was associated with high satisfaction among the specialists. Neurologists identified patient education from the specialist (72.5%) as the most useful tool, in their experience, to improve patients\u2019 understanding of the disease and treatment options.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusion<\/jats:title>\n                    <jats:p>Participating neurologists perceived that fluctuations and OFF periods can impair patients\u2019 daily activities and overall well-being. On-demand treatment with inhaled levodopa was perceived by the neurologists as a useful option in the management of OFF episodes, especially those associated with wearing-off episodes and morning akinesia. Participants considered that initiation of on-demand treatments, along with improved patient education, may support the management of fluctuations in clinical practice.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.3389\/fneur.2026.1869776","type":"journal-article","created":{"date-parts":[[2026,9,14]],"date-time":"2026-09-14T04:32:48Z","timestamp":1789360368000},"update-policy":"https:\/\/doi.org\/10.3389\/crossmark-policy","source":"Crossref","is-referenced-by-count":0,"title":["Clinician perspectives on OFF periods in Parkinson\u2019s disease: the Spanish PARK-OFF survey-based study"],"prefix":"10.3389","volume":"17","author":[{"given":"Javier","family":"Ruiz-Mart\u00ednez","sequence":"first","affiliation":[{"name":"Movement Disorders Unit, Neurology Department, Donostia University Hospital","place":["Donostia-San Sebasti\u00e1n, Spain"]},{"name":"Neurodegenerative Diseases Area, ISS Biogipuzkoa","place":["Donostia-San Sebasti\u00e1n, Spain"]},{"name":"CIBERNED (Center for Networked Biomedical Research on Neurodegenerative Diseases)","place":["Madrid, Spain"]},{"name":"Department of Neurosciences, University of the Basque Country (UPV\/EHU)","place":["Donostia-San Sebasti\u00e1n, Spain"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Elisabet Mondrag\u00f3n","family":"Rezola","sequence":"additional","affiliation":[{"name":"Movement Disorders Unit, Neurology Department, Donostia University Hospital","place":["Donostia-San Sebasti\u00e1n, Spain"]},{"name":"Neurodegenerative Diseases Area, ISS Biogipuzkoa","place":["Donostia-San Sebasti\u00e1n, Spain"]},{"name":"CIBERNED (Center for Networked Biomedical Research on Neurodegenerative Diseases)","place":["Madrid, Spain"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Ana Vinagre","family":"Arag\u00f3n","sequence":"additional","affiliation":[{"name":"Movement Disorders Unit, Neurology Department, Donostia University Hospital","place":["Donostia-San Sebasti\u00e1n, Spain"]},{"name":"Neurodegenerative Diseases Area, ISS Biogipuzkoa","place":["Donostia-San Sebasti\u00e1n, Spain"]},{"name":"CIBERNED (Center for Networked Biomedical Research on Neurodegenerative Diseases)","place":["Madrid, Spain"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Lara Pardina","family":"Vilella","sequence":"additional","affiliation":[{"name":"Movement Disorders Unit, Neurology Department, Donostia University Hospital","place":["Donostia-San Sebasti\u00e1n, Spain"]},{"name":"Neurodegenerative Diseases Area, ISS Biogipuzkoa","place":["Donostia-San Sebasti\u00e1n, Spain"]},{"name":"CIBERNED (Center for Networked Biomedical Research on Neurodegenerative Diseases)","place":["Madrid, Spain"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Mar\u00eda Sof\u00eda C\u00e1mara","family":"Marcos","sequence":"additional","affiliation":[{"name":"Movement Disorders Unit, Neurology Department, Donostia University Hospital","place":["Donostia-San Sebasti\u00e1n, Spain"]},{"name":"Neurodegenerative Diseases Area, ISS Biogipuzkoa","place":["Donostia-San Sebasti\u00e1n, Spain"]},{"name":"CIBERNED (Center for Networked Biomedical Research on Neurodegenerative Diseases)","place":["Madrid, Spain"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"David Campo","family":"Caballero","sequence":"additional","affiliation":[{"name":"Movement Disorders Unit, Neurology Department, Donostia University Hospital","place":["Donostia-San Sebasti\u00e1n, Spain"]},{"name":"Neurodegenerative Diseases Area, ISS Biogipuzkoa","place":["Donostia-San Sebasti\u00e1n, Spain"]},{"name":"CIBERNED (Center for Networked Biomedical Research on Neurodegenerative Diseases)","place":["Madrid, Spain"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"name":"On behalf of the PARK-OFF Study 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