title: [Drug treatment of early-stage (de novo and "honeymoon") Parkinson disease].
abstract: In this article, we discuss the management of motor symptoms during the early phases of Parkinson's disease, excluding that of any other clinical manifestation. We relied primarily upon recently published data and do not describe older publications relating to anticholinergic drugs or amantadine. The initial pharmacological treatment of idiopathic Parkinson's disease (IPD) is symptomatic and remains based upon dopaminergic drugs. However, the development of new drugs has broadened the range of strategic options and improved overall patient management. Announcing the diagnosis is a critical moment, as pointed out by patients' associations. Patients should be advised to maintain personal, professional, social and physical activities as long as possible. The potential benefit of early pharmacological treatment should be explained, focusing on the possible disease-modifying effect of drugs such as rasagiline. According to current guidelines, L-Dopa is preferred in patients above 65years of age, while those below 65 should be treated with dopamine agonists. Like monoamine oxidase inhibitors B (MAOI-B), synthetic dopamine agonists exhibit several advantages: easy-to-use treatment with a once-daily administration, delayed L-Dopa initiation, significant efficacy on motor symptoms (although lower than that of L-Dopa). MOAI can be prescribed in association with L-Dopa or dopamine agonists. Rasagiline also delays L-Dopa initiation, and consequently motor complications.
authors.affiliation: Département de neurosciences cliniques, pôle neurolocomoteur, Inserm U955, équipe NPI, hôpital Henri-Mondor, groupe hospitalier Henri-Mondor, université UPEC-Paris XII Créteil, bâtiment R, 51, avenue du Maréchal-de-Lattre-de-Tassigny, 94010 Créteil cedex, France.
authors.forename: P
authors.initials: P
authors.lastname: Cesaro
authors.affiliation: Service de neurologie et pathologie du mouvement, pôle de neurosciences et de l'appareil locomoteur, hôpital Salengro, EA 1046, faculté de médecine, université Lille Nord-de-France, avenue du Pr-Émile-Laine, 59037 Lille cedex, France. Electronic address: luc.defebvre@chru-lille.fr.
authors.forename: L
authors.initials: L
authors.lastname: Defebvre
mesh_terms: D000368:Aged; D000928:Antidepressive Agents / Q000627:therapeutic use; D000978:Antiparkinson Agents / Q000627:therapeutic use*; D005260:Female; D006801:Humans; D007189:Indans / Q000009:adverse effects / Q000627:therapeutic use; D008297:Male; D008875:Middle Aged; D018696:Neuroprotective Agents / Q000009:adverse effects / Q000627:therapeutic use; D010300:Parkinson Disease / Q000188:drug therapy* / Q000523:psychology
chemical_list: D000928:Antidepressive Agents; D000978:Antiparkinson Agents; D007189:Indans; D018696:Neuroprotective Agents; C031967:rasagiline
keywords: Agonistes dopaminergiques; Dopamine agonists; IMAO; L-Dopa; Levodopa; Maladie de Parkinson; Monoamine oxidase inhibitors; Parkinson's disease; Stratégie thérapeutique; Therapeutic strategy