title: [On-off fluctuations]
abstract: Fluctuations in the efficacy of dopaminergic treatment are defined as the intermittent recurrence of parkinsonian features during the day. After a disease duration of 5 years, over 50 p. 100 of patients already experience this complication, due both to disease progression and the treatment itself. We are now starting to understand the mechanisms responsible for fluctuations: while pharmacokinetic alterations of dopamine in the brain (i.e. a reduction in dopamine storage capacity) are clearly involved, there are also complex postsynaptic anomalies, affecting all the basal ganglia circuitry. A careful semiologic analysis will help to establish the precise chronology of the fluctuations and their position with respect to drug intake. This is an essential step before any attempt is made to correct them.
authors.affiliation: Clinique Neurologique, Centre d'Investigation Clinique, INSERM U437, CHUNantes.
authors.forename: Ph.
authors.initials: P
authors.lastname: Damier
vernacular_title: Les fluctuations.