[Initial management and adaptation of Parkinson's disease treatment]

The initial management of Parkinson's disease and is adaptation is presented. Levodopa remains the most efficacious treatment of the disease. However, with the long term, the efficacity of the drug is slowing down and secondary effects are frequent. The pros and cons of various therapy are discussed. If the patient is younger than 65 years, we would usually start therapy with a dopamine agonist because of the lower risk of motor complications. Levodopa is a potent alternative and can be given if there is an inadequate response to the agonist. When motor complications are present, some options are usefull like the administration of dopaminergic agonists or apomorphine, the utilisation of inhibitors of the dopamine catabolism, the deep brain stimulation and the jejunal administration of dopa.