From the Research
Leg heaviness in Parkinson's disease should be addressed by optimizing dopaminergic medication regimens, utilizing physical therapy, and managing orthostatic hypotension to improve morbidity, mortality, and quality of life outcomes. To address leg heaviness in Parkinson's disease, it is essential to consider the most recent and highest quality evidence available. According to a study published in 2020 1, Parkinson's disease is a heterogeneous disease with rapidly and slowly progressive forms, and treatment involves pharmacologic approaches, such as levodopa preparations, and nonpharmacologic approaches, including exercise and physical therapy. The study published in 2023 2 highlights the importance of dopamine agonists in Parkinson's therapy, but it is crucial to note that the most recent and highest quality evidence should guide treatment decisions. Another study published in 2022 3 found that perceived lower limb weakness and allied abnormal sensations are common in patients with Parkinson's disease, but there is a dissociation between perceived weakness and objective muscle strength in the lower limbs. Given this evidence, optimizing dopaminergic medication regimens by ensuring consistent dopamine levels, utilizing physical therapy focusing on leg strengthening exercises and regular walking, and managing orthostatic hypotension with hydration, salt intake, compression stockings, and sometimes medications like midodrine or fludrocortisone can significantly improve leg heaviness and overall quality of life in patients with Parkinson's disease. Key considerations include:
- Optimizing dopaminergic medication regimens to maintain consistent dopamine levels
- Utilizing physical therapy to improve leg strength and mobility
- Managing orthostatic hypotension to prevent blood pressure drops that may contribute to leg heaviness
- Considering the use of COMT inhibitors or MAO-B inhibitors to extend levodopa's effectiveness if experiencing "wearing off" between doses.