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Motor Symptoms

Symptoms of Parkinson’s disease vary from person to person and change over time. But a Parkinson’s diagnosis will only be considered when two of the four main motor symptoms are present over a period of time.

The four main motor symptoms of Parkinson’s disease are:

Slowness of movement, also called bradykinesia. This symptom makes it harder to initiate and perform physical actions such as getting out of bed, buttoning a shirt or even speech. 

Involuntary shaking, or tremor at rest.  Tremor usually occurs in the hands, but it can also appear in other parts of the body, including the lower lip, jaw or leg. This symptom usually improves when a person starts performing tasks or using the limb in some way.

Stiffness of the arms, legs or trunk. Muscles feel unusually tight, stiff or achy. This symptom can occur on one side or both sides of the body.

Trouble with balance and falls, also called postural instability. A person with postural instability will have problems with walking, balance and turning around. Falls may occur without explanation. Postural instability isn’t usually present with diagnosis, but it’s one of the most common and troublesome symptoms that happens later on.

Secondary symptoms of Parkinson’s include:

  • Small, cramped handwriting, called micrographia.
  • Reduced arm swing on the affected side.
  • Slight foot drag on the affected side, resulting in a shuffled walk.
  • Freezing — a term used to describe the phenomenon of being stuck in place when attempting to walk.
  • Loss of facial expression due to rigidity of facial muscles, called hypomimia.
  • Low voice volume or muffled speech, called hypophonia.
  • Tendency to fall backwards, called retropulsion.
  • Decreased ability in automatic reflexes such as blinking and swallowing.


Dyskinesias are involuntary, erratic writhing movements of the face, arms, legs, and trunk.  Levodopa therapy is typically the cause of dyskinesias, but other drugs such as dopamine agonists, COMT inhibitors, and MAO-B inhibitors can worsen dyskinesias. They usually occur one to two hours after a dose of levodopa has been absorbed into the bloodstream and is at its peak levels in the brain. Dyskinesias usually begin after a few years of treatment with levodopa. Often, they can be alleviated by adjustments in medications.

Page reviewed by Dr. Joash Lazarus, NPF Movement Disorders Fellow, Department of Neurology at Emory University School of Medicine.

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