A planned, intentional interruption of medication therapy, also called a structured treatment interruption (STI). The premise is that this interruption gives the person with Parkinson’s and his or her physician the opportunity to see a comprehensive representation of Parkinson’s symptoms by removing any “masking” that anti-parkinson’s medications may provide. A drug holiday generally is considered when a person is taking multiple medications and is not receiving complete symptom relief. it is a controversial method, as some experts believe this gives the person’s body a chance to clear out all drugs and start “fresh” with a new treatment regimen and others believe that suddenly depriving the brain of chemicals it has begun to depend on risks an intense surge of symptoms that then may become difficult to return under control.
A person with Parkinson’s who is considering a drug holiday should make sure he or she fully understands what to expect and should attempt this method only when close observation is available (many experts recommend hospitalization) so that immediate medical attention is always available. Withdrawing anti-Parkinson’s medications can leave the person nearly paralyzed, depending on the extent of dopaminergic neuron loss and dopamine depletion in the brain. Difficulty in swallowing and breathing can produce a potentially life-threatening problem that must be addressed on an urgent basis. Patients on a large dose of dopaminergic medications also bear some risk of the onset of severe muscle rigidity, fever, and autonomic disturbances, such as a very volatile blood pressure (so-called neuroleptic malignant syndrome, or occulogyric crises in cases where tonic eye deviation is prominent) with an abrupt cessation of medications.
Even after the person’s system is purged of all drugs, the person does not return to a state of de novo Parkinson’s. Once treatment has been started, it creates irreversible changes in the dopamine network. For most people with Parkinson’s whose disease is in the middle to late stages (the point at which a drug holiday typically is considered), resumption of medication is more likely to entail a return to a full-scale regimen than a gradual reintroduction of drugs.
