[Continuous dopaminergic stimulation, pulsatile dopaminergic stimulation]

Levodopa is the gold standard treatment for Parkinson's disease. The therapeutic effect may however be compromised by the inevitable risk of motor complications, with fluctuating motor control and dyskinesia, particularly in the younger patient. The Multiple pathophysiological mechanisms are undoubtedly involved but pulsed dopaminergic stimulation appears to play a determining role. This underlines the importance of a treatment which achieves a most stable and physiological dopaminergic stimulation as possible. Dopaminergic agonists provide a promising alternative. Another possibility is to modulate the peripheral kinetics of levodopa as soon as it is introduced using catechol-O-methyl transferase inhibitors.