[Parkinson's disease treatment: from honey moon to motor fluctuations]

Parkinson's disease treatment: from honey moon to motor fluctuations. The treatment of Parkinson's disease remains symptomatic but allows, for many years, a good control of motor and non-motor signs. This treatment is complex and has to deal with very heterogeneous motor and non-motor presentation. Initial treatment is started once disability occurs and is mainly based either on levodopa or dopamine agonists. When motor fluctuations start, the principle of treatment is to optimize levodopa intake and combine various drugs depending on the clinical presentation. Third line strategies of treatment such as pumps or deep brain stimulation may be proposed at this stage. Later on, when doparesistant signs appear, treatment has often to be simplified, cognitive decline to be taken in charge and physiotherapy is crucial even if physical exercise is of great importance whatever the stage of the disease. Finally, non-motor manifestations have to be carefully addressed throughout the course of the disease because their impact on quality of life is sometimes greater than the one of motor signs.