[Medical and surgical treatment of Parkinson's disease]

The treatment of Parkinson's disease is symptomatic with the use of dopaminergic medications: levodopa, dopaminergic agonists and enzymatic inhibitors. At the initial stage, the main goals are to improve the quality of life of patients and delay the onset of motor complications, using a combination of these therapies taking into account both clinical disability and tolerance of different treatments. At the stage of motor and non-motor fluctuations inhibitors of MAO-B and COMT are proposed; amantadine may limit moderate dyskinesias. At the stage of disabling fluctuations continuous dopaminergic strategy is discussed: deep brain stimulation of different targets, subcutaneous apomorphine pump and intra intestinal Duodopa^® administration. The monitoring of side effects remains essential for an early adjustment of medications; mainly nausea, orthostatic hypotension, drowsiness and sleep attacks, dyskinesias and behavioral disorders (hallucinations, impulse control disorders). A care pathway published in 2014 by the HAS develops the management process of parkinsonism and its multidisciplinary outpatient.