The ‘Go, No-Go’ Effect in Parkinson’s Is More Than Restlessness

My worst Parkinson’s symptom used to be pain. Now, it’s the “go, no-go” effect, which greatly limits my ability to function.

“Go, no-go” is an urgency to move, a severe restlessness, followed by a severe resistance to moving. This experience — craving to move, mixed with dampened movement, but once moving I can’t stop — is so unusual that it seems unrecognizable. I’m either held still by the disease, or I’m forced to accelerate.

This episodic state, where my perception of the need to move is overwhelming, is my chief nemesis. It inhibits my meditation, interrupts my sleep, and is annoying to Mrs. Dr. C, as she stands helpless watching me rev up into relentless motion without directed purpose.

Researchers in 2011 identified this “go, no-go” effect. It’s more than mere restlessness. The paradox is that even though there’s this burning desire (or mental demand) to move, the initiation of movement to meet that desire is sometimes accompanied by resistance. This is the “go, no-go,” and it’s part of my everyday life with Parkinson’s disease (PD).

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A multitude of events can trigger an urge to suddenly get up and start doing. I’ve gotten up, dressed in dressy casual clothes (versus gardening attire), and announced to an unsuspecting Mrs. Dr. C that I’m ready to go.

“Go where?” Mrs. Dr. C questions. There wasn’t an appointment on the calendar. At 7 a.m., my “go, no-go” had kicked in. I felt an overwhelming pressure that I should be going … somewhere. I’d forgotten my check-in to halt the effect.

When I do the “go, no-go” check-in, I’m reviewing if my need to move is true. I experience all the noise. I know I should stop, but I don’t want to.

The “go, no-go” effect begins with a sensation like having a few drinks. I feel good, and I’m ready to dance about the room with the lampshade on my head. I often can’t tell this is happening until I look back with hindsight. It’s then I see that I expended more energy doing things that weren’t necessary and interfered with the application of my self-management toolkit.

Research suggests that Parkinson’s patients have good insight into their daily functioning. Oliver Sacks, the doctor and memoirist, said that most PD patients retain their higher cognitive functioning despite the “go, no-go” effect. I find that if I calm my mind using those higher functions, then I can get control of “go, no-go.”

It’s not an easy thing to learn. The louder the noise to do something is, the louder the resistance, and both demand my attention. To make matters worse, I often cannot accurately perceive the effect until after I stop moving. Only after I sit calmly in the meditative posture can I tune in to my inner self.

“No-go” now means that every time I get this urge to go, to move, to grasp, that’s when my first response should be “no-go.” I stop and take the time to do an inner check: “How noisy is the chatter in my Parkinson’s brain right now?”

If there’s a lot of brain noise, then going increases the risk that I’ll cross the threshold, drain the well of resources, and then devolve into a zombie state for several days.

The other thing I’ve discovered is that I must practice the shift from wanting to do something to finding ordinary calmness. By practicing this shift, I become more resistant to being hijacked by this noisy “go, no-go” effect.

Not all desire to get up and show up is problematic. “Showing up” is our description of the ability to attend to a project, work on it diligently (sometimes only an hour or so a day), and see it through to completion. It’s only when I’m reacting to chaotic brain noise that my efforts aren’t directed toward constructive action. I’m just grasping and flailing.

The “go, no-go” effect hits me several times a day. Sometimes I can control it, and sometimes I cannot. But improvement on managing it extends to maintaining my health and well-being and being present for my family. It can be tricky to sort out.

I’m still working on identifying when the “go, no-go” effect needs my attention as a signal to shift to calm. I must be observant to see the trigger. This gentle, observing practice is a new tool in my self-management toolkit.

Note: Parkinson’s News Today is strictly a news and information website about the disease. It does not provide medical advice, diagnosis, or treatment. This content is not intended to be a substitute for professional medical advice, diagnosis, or treatment. Always seek the advice of your physician or another qualified health provider with any questions you may have regarding a medical condition. Never disregard professional medical advice or delay in seeking it because of something you have read on this website. The opinions expressed in this column are not those of Parkinson’s News Today or its parent company, Bionews, and are intended to spark discussion about issues pertaining to Parkinson’s disease.