What ON and OFF actually mean in your report
In Parkinson's care, ON refers to the period when levodopa or related medication is working and your movement symptoms are at their best. OFF refers to the period when the effect has worn off and symptoms return or worsen. A diagnosis report that lists only 'ON: improved, OFF: worse' tells a reviewing clinician almost nothing about your individual pattern.
The report should separate which symptoms change between states. Tremor, slowness, stiffness, walking, balance, speech and involuntary movements may each respond differently. Some people have good control of slowness but persistent tremor; others have troublesome OFF periods with pain, anxiety or a return of freezing. These distinctions matter because they influence which treatment questions are worth asking.
Ask for the timing to be recorded as well. How long after each dose does ON begin, how long does it last, and when does OFF return? A report that captures only a single clinic visit may miss the pattern across a whole day. If your own diary exists, it can be useful supporting information, but the treating team decides how much weight to give it.
Why levodopa response is the central question
The degree to which symptoms improve with levodopa is one of the factors clinicians consider when discussing advanced therapies. A clear response suggests that the brain pathways involved in movement still respond to dopamine replacement, which is relevant when assessing options such as deep brain stimulation. A poor or inconsistent response raises different questions and may point the assessment in another direction.
Your report should state whether the response was judged adequate, partial or uncertain, and on what evidence. Was it based on a formal levodopa challenge, a diary, or the clinician's observation over time? If the basis is not stated, a reviewing specialist cannot tell how strong the conclusion is.
This is not a decision you should make from the report alone. Whether a particular response pattern makes you suitable for a specific procedure is a clinical judgement that depends on your full history, imaging, cognitive assessment and other factors. The report should give the reviewer enough to ask the right follow-up questions, not to reach a conclusion by itself.
The records a specialist needs alongside the ON and OFF summary
An ON and OFF summary is most useful when it sits alongside the rest of the diagnosis record. A reviewing clinician will typically want to see when Parkinson's was diagnosed and by whom, what medicines you take and at what times, and how your regimen has changed over time. A list of current medicines with doses and timing is more useful than a general statement such as 'on standard treatment'.
Motor and non-motor symptoms should both appear. Sleep, mood, cognition, blood pressure on standing, bladder and bowel function, and pain can all change between ON and OFF states, and they affect how a clinician weighs the risks and benefits of any advanced option. If these are absent, ask whether they can be added or clarified before the records are sent.
Imaging and other test results should be included where they exist, with the original reports rather than a summary alone. If a test was done elsewhere and the images are available, ask the treating team whether those images can be shared. The receiving hospital will decide what it needs; your role is to provide what you can and to ask what is missing.
- Diagnosis date, clinician and setting
- Current medicines with doses and timing
- Motor symptoms in ON and OFF states
- Non-motor symptoms in ON and OFF states
- Relevant imaging and test reports
- Your main question for the review
What the report cannot tell you about device and follow-up choices
Deep brain stimulation uses implanted electrodes and a pulse generator. It may help selected Parkinson's symptoms but does not cure the disease. A diagnosis report can describe your symptom pattern and medication response, but it cannot by itself establish whether you are a candidate for a device, which device would be used, or how programming and follow-up would be arranged.
Those questions belong to the treating team. They depend on factors such as your age, cognitive status, response to medication, other health conditions and your own goals. If you are considering care in China, ask the hospital how it assesses candidates, what investigations it requires before a decision, and how follow-up and device programming are handled for international patients.
Do not assume that a device or a particular programming schedule will be available to you. Availability, compatibility with any existing device, and arrangements for ongoing adjustment are questions to confirm with the specific hospital and clinical team, not facts that can be inferred from a report or from practice elsewhere.
How to prepare the report for a records-based review in China
If you are asking a Chinese specialist to review your records, the goal is a clear, complete picture that supports a useful opinion. Start with a short summary in English that states your diagnosis, your main question, and the specific decision you are trying to make. Then attach the supporting documents in a logical order.
A translated summary can help, but the original reports should also be available. Ask the hospital whether it needs certified translation or whether a working translation is acceptable for an initial review. Do not send passport numbers, payment details or a complete lifetime archive at the first contact; a brief summary and the key reports are enough to begin.
Be explicit about what you want from the review. Are you asking whether advanced therapy is worth exploring, whether your current regimen could be reconsidered, or whether a second opinion supports the plan you already have? A focused question produces a more useful response than a general request for 'the best treatment'.
Questions to ask before you rely on any report
Before you treat a diagnosis report as the basis for a decision, check what it actually contains. Ask who recorded the ON and OFF assessments, whether they were based on a formal protocol or clinical impression, and whether the same method was used each time. If the method changed, the comparison may be less reliable.
Ask what is missing. If non-motor symptoms, cognitive assessment or a medication diary are absent, ask whether they can be added. If the report does not state the basis for the levodopa response conclusion, ask for that to be clarified. A reviewing clinician can work with uncertainty, but only if the uncertainty is visible.
Finally, ask the receiving hospital what it will do with the records. Does it offer a records-based opinion, and what are the limits of that opinion? A remote review can help you understand your options and prepare questions, but it does not replace an in-person assessment and does not guarantee acceptance for any procedure. The hospital decides suitability after its own evaluation.
If you would like to start, you can send a brief summary of your diagnosis and your main question through the enquiry form. The initial review is free and is not a diagnosis or a promise of acceptance. It identifies missing information and suggests a relevant next step, which may include a specialist appointment or a records-based opinion. You do not need to purchase a proxy consultation to make an initial enquiry.
Sources & scope of this guide
References and official service information relevant to this guide.
This is general planning information and has not been individually reviewed by a doctor. Medical decisions and personal treatment advice come from your treating clinicians.