[Therapeutic strategies for Parkinson's disease]

The remarkable efficacy of L-dopa on the akinesia, tremor and rigidity of Parkinson's disease is incontestable. It is responsible for the functional improvement and the regained quality of life. Unfortunately, after this classical "honeymoon" appear the "motor complications of dopamine therapy" (MCD), motor fluctuations and dyskinesia. Even more frequent and severe when the patient is young, it compromises the patient's autonomy. Certainly, the manipulation of L-dopa, the modification of its metabolism, and its association with an agonist permit amelioration but this is inconstant, imperfect and brief. The pulsatility of dopaminergic stimulation is the determinant physiopathological element in the genesis of MCD. New strategies of anti-Parkinsonian treatment find there within their justification. Some of them aim to treat the MCD: the high frequency electric stimulation of the sub-thalamic core is the most recent example. The criteria of selection for the electric stimulation should be respected in order to ensure its efficacy. These symptomatic treatments however, have no influence on the natural history of the disease and/or the affect on other dopaminergic systems. Perhaps hope should rather be placed in neuroprotection.