[Therapeutic and pharmacologic perspectives in Parkinson's disease]

Therapeutic and pharmacologic perspectives in parkinson's disease. Despite the dopaminergic therapy which improves motor symptoms, there are still a lot of challenges to be fulfilled in Parkinson's disease. Dopamine replacement therapy is hampered by motor complications, has no efficacy on non-motor symptoms, and is not neuroprotective so does not change disease progression. Second line therapies, also mainly acting on motor symptoms, such as deep brain stimulation, and continuous administration of levodopa or apomorphine by pumps, can benefit to a limited number of patients but are associated with a high burden for the patients and their caregivers, and a high cost for society. Several therapeutic strategies are currently under evaluation to improve the treatment of motor fluctuations, dyskinesia, and some non-motor symptoms. The recent development of more predictive preclinical models and biomarkers of disease progression should allow fostering the development of innovative neuroprotective strategies. The stratification of patients through the combination of clinical, biological and brain imaging features will help to move towards personalized precision medicine by matching patients care to their individual progression profile.