title: [Medical and surgical treatment of Parkinson's disease].
abstract: The treatment of Parkinson's disease is symptomatic with the use of dopaminergic medications: levodopa, dopaminergic agonists and enzymatic inhibitors. At the initial stage, the main goals are to improve the quality of life of patients and delay the onset of motor complications, using a combination of these therapies taking into account both clinical disability and tolerance of different treatments. At the stage of motor and non-motor fluctuations inhibitors of MAO-B and COMT are proposed; amantadine may limit moderate dyskinesias. At the stage of disabling fluctuations continuous dopaminergic strategy is discussed: deep brain stimulation of different targets, subcutaneous apomorphine pump and intra intestinal Duodopa®administration. The monitoring of side effects remains essential for an early adjustment of medications; mainly nausea, orthostatic hypotension, drowsiness and sleep attacks, dyskinesias and behavioral disorders (hallucinations, impulse control disorders). A care pathway published in 2014 by the HAS develops the management process of parkinsonism and its multidisciplinary outpatient.
authors.affiliation: Université de Lille, faculté de médecine, CHRU de Lille, centre expert Parkinson, hôpital Salengro, service de neurologie et pathologie du mouvement, Inserm 1171, 59037 Lille, France. Electronic address: luc.defebvre@chru-lille.fr.
authors.forename: Luc
authors.initials: L
authors.lastname: Defebvre
authors.affiliation: Université de Lille, faculté de médecine, CHRU de Lille, centre expert Parkinson, hôpital Salengro, service de neurologie et pathologie du mouvement, Inserm 1171, 59037 Lille, France.
authors.forename: Caroline
authors.initials: C
authors.lastname: Moreau
mesh_terms: D000978:Antiparkinson Agents / Q000627:therapeutic use*; D001058:Apomorphine / Q000627:therapeutic use; D065105:Aromatic Amino Acid Decarboxylase Inhibitors / Q000627:therapeutic use; D065098:Catechol O-Methyltransferase Inhibitors / Q000627:therapeutic use; D003131:Combined Modality Therapy; D046690:Deep Brain Stimulation / Q000009:adverse effects / Q000379:methods; D018450:Disease Progression; D018491:Dopamine Agonists / Q000627:therapeutic use; D005549:Foreign-Body Reaction / Q000209:etiology; D006801:Humans; D020300:Intracranial Hemorrhages / Q000209:etiology; D008996:Monoamine Oxidase Inhibitors / Q000627:therapeutic use; D019964:Mood Disorders / Q000209:etiology; D010300:Parkinson Disease / Q000188:drug therapy / Q000628:therapy*; D018579:Patient Selection; D011788:Quality of Life
chemical_list: D000978:Antiparkinson Agents; D065105:Aromatic Amino Acid Decarboxylase Inhibitors; D065098:Catechol O-Methyltransferase Inhibitors; D018491:Dopamine Agonists; D008996:Monoamine Oxidase Inhibitors; D001058:Apomorphine