[Second-line treatments for Parkinson's disease]

Following an initial phase characterized by a good response to dopaminergic therapies, Parkinson's disease progresses toward a stage marked by motor complications-notably motor fluctuations and dyskinesias. When the optimization of oral therapy proves insufficient, the use of second-line treatments must be considered. These strategies are based on three main approaches: deep brain stimulation, continuous subcutaneous infusions (apomorphine, foslevodopa-foscarbidopa), and intra-intestinal levodopa infusions. The indication for these therapies depends on a multidisciplinary assessment that considers dopa-responsiveness, motor and cognitive status, comorbidities, and the patient's lifestyle. At least 5 doses of L-dopa, 2 hours of OFF and 1 hour of disabling dyskinesias every day constitute a simple tool to identify eligible patients in routine practice. Therapeutic choices must be individualized, balancing efficacy, tolerability, and practical constraints. General practitioners play an essential role in identifying complications, monitoring treatment, and coordinating care. Early collaborative management can significantly improve patients' quality of life.