[Parkinson disease: interrogations and solutions].

Abstract

A NEURODEGENERATIVE DISEASE: Idiopathic Parkinson's disease is initially due to a selective and specific destruction of the pars compacta dopaminergic neurons in substantia nigra. Since the inaugural description in 1817 by J. Parkinson, therapeutic progress rapidly accelerated mainly due to a better knowledge of the neurobiology of the central nervous system dopaminergic pathways. THERAPEUTIC GOAL: The question today is not merely to give a short term pharmacological benefit but to maintain a long-term effect while avoiding motor complications such as fluctuations, dystonias and dyskinesias. This goal can be achieved while using low doses of levodopa, dopaminergic agonists and inhibitors of monoamine-oxydase-B. PERSPECTIVES: Some more improvements are expected through new avenues (inhibitors of catechol-O-methyl transferase, thalamic stimulation, fetal grafts). The main challenge is represented by compounds potentially antagonizing cell death. In any case, the therapeutic approaches have to be guided by good quality clinical trials.