{"id":27,"date":"2022-04-18T11:04:42","date_gmt":"2022-04-18T10:04:42","guid":{"rendered":"https:\/\/www.d-minecare.com\/fra\/diagnosis\/"},"modified":"2025-09-25T11:42:22","modified_gmt":"2025-09-25T10:42:22","slug":"maladie-de-parkinson","status":"publish","type":"page","link":"https:\/\/www.d-minecare.com\/fra\/maladie-de-parkinson\/","title":{"rendered":"Maladie de Parkinson"},"content":{"rendered":"\n
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Diagnostic<\/h2>\n\n\n\n

Il n\u2019existe, \u00e0 l\u2019heure actuelle, aucun biomarqueurs, examens de neuro-imagerie ou autres tests cliniques disponibles pour confirmer le diagnostic pr\u00e9coce de la maladie de parkinson, il peut ainsi \u00eatre difficile \u00e0 \u00e9tablir. Le diagnostic de la maladie de Parkinson est actuellement bas\u00e9 sur la pr\u00e9sence ou l’absence de plusieurs sympt\u00f4mes associ\u00e9s \u00e0 l\u2019expertise clinique m\u00e9dicale.<\/p>\n\n\n\n

Les signes cliniques et sympt\u00f4mes pr\u00e9sents au d\u00e9but de la maladie de Parkinson sont communs \u00e0 d\u2019autres maladies, en particulier d’autres formes de syndrome parkinsonien. Ces autres formes peuvent \u00eatre : l’atrophie multi-syst\u00e9matis\u00e9e, le syndrome parkinsonien induit par les traitements m\u00e9dicamenteux, le syndrome parkinsonien d\u2019origine vasculaire, ainsi que la d\u00e9mence \u00e0 corps de Lewy et le tremblement essentiel. Cependant, le diagnostic de la MP peut \u00eatre \u00e9tabli avec un degr\u00e9 de pr\u00e9cision assez \u00e9lev\u00e9 s\u2019il repose sur les caract\u00e9ristiques cliniques combin\u00e9es \u00e0 une r\u00e9ponse aux m\u00e9dicaments antiparkinsoniens, en particulier lorsqu’il est fait par un m\u00e9decin sp\u00e9cialiste des troubles du mouvement.1<\/sup><\/p>\n\n\n\n

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Sympt\u00f4mes et Progression<\/h2>\n\n\n\n

Les patients pr\u00e9sentent g\u00e9n\u00e9ralement une tr\u00e8s bonne r\u00e9ponse \u00e0 la l\u00e9vodopa pendant les premiers stades du traitement et les effets de la l\u00e9vodopa persistent m\u00eame en cas d’oubli d’une prise de m\u00e9dicament. Au fur et \u00e0 mesure que la maladie progresse, l’effet de la l\u00e9vodopa entre 2 prises s\u2019amenuise et les patients sont soumis \u00e0 des phases \u00ab ON \u00bb et \u00ab OFF \u00bb. Pendant les phases \u00ab ON \u00bb, les patients b\u00e9n\u00e9ficient d’un bon effet antiparkinsonien de la l\u00e9vodopa et d’une fonction motrice normale. Pendant les phases \u00ab OFF \u00bb, les patients sont moins en mesure de contr\u00f4ler la fonction motrice.2<\/sup> <\/p>\n\n\n\n

Au fur et \u00e0 mesure que la maladie de Parkinson progresse, on observe une perte progressive des neurones dopaminergiques impliqu\u00e9s dans le stockage, l’absorption et la lib\u00e9ration de la dopamine. La stimulation des r\u00e9cepteurs de la dopamine d\u00e9pend ainsi de plus en plus de la disponibilit\u00e9 p\u00e9riph\u00e9rique de la l\u00e9vodopa dans le plasma. Par exemple, dans les premiers stades de la maladie, les terminaisons dopaminergiques stri\u00e9es peuvent att\u00e9nuer les fluctuations des taux de l\u00e9vodopa dans le plasma, ce qui permet aux r\u00e9cepteurs de la dopamine d’\u00eatre stimul\u00e9s de mani\u00e8re relativement continue. Cependant, au fil de la maladie, les r\u00e9cepteurs de la dopamine sont davantage expos\u00e9s aux fluctuations des niveaux de la dopamine dans le striatum induites par la perte progressive des terminaisons dopaminergiques et la courte demi-vie de la l\u00e9vodopa.2<\/sup><\/p>\n\n\n\n

La stimulation intermittente ou pulsatile des r\u00e9cepteurs dopaminergiques serait responsable du d\u00e9veloppement des fluctuations motrices et des dyskin\u00e9sies qui compliquent l’utilisation \u00e0 long terme du traitement par la l\u00e9vodopa dans la maladie de Parkinson.3<\/sup><\/p>\n\n\n\n

Les fluctuations motrices se produisent aux stades mod\u00e9r\u00e9s\/interm\u00e9diaires et avanc\u00e9s de la maladie de Parkinson (voir sch\u00e9ma ci-dessous). Elles sont annonc\u00e9es par l\u2019apparition d\u2019une akin\u00e9sie du r\u00e9veil et d\u2019une akin\u00e9sie de fin de dose; elles deviennent ensuite plus soudaines, plus intenses et impr\u00e9visibles (ph\u00e9nom\u00e8nes on\/off).4<\/sup><\/a><\/p>\n\n\n\n

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Des complications motrices apparaissent chez environ 50 \u00e0 90 % des patients atteints de la MP qui ont re\u00e7u un traitement par l\u00e9vodopa pendant 5 \u00e0 10 ans. Elles constituent une source majeure d’invalidit\u00e9. <\/strong>Ces sympt\u00f4mes sont particuli\u00e8rement fr\u00e9quents chez les patients atteints de MP d\u2019apparition pr\u00e9coce (presque 100% des cas) et ils sont moins susceptibles d’appara\u00eetre chez les patients dont les sympt\u00f4mes d\u00e9butent apr\u00e8s 70 ans. De plus, ces sympt\u00f4mes ont tendance \u00e0 \u00eatre observ\u00e9s plus fr\u00e9quemment en association avec de fortes doses de l\u00e9vodopa.5<\/sup> <\/p>\n\n\n\n

Les patients trait\u00e9s par l\u00e9vodopa d\u00e9veloppent \u00e9galement des dyskin\u00e9sies (par exemple des mouvements involontaires). En r\u00e8gle g\u00e9n\u00e9rale, ces dyskin\u00e9sies peuvent \u00eatre li\u00e9es \u00e0 des concentrations excessives de l\u00e9vodopa dans le plasma et au pic de la r\u00e9ponse motrice. On parle alors de dyskin\u00e9sie de pic de dose.2<\/sup> <\/p>\n<\/div><\/div>\n<\/div><\/div>\n\n\n\n

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Options de traitement<\/h2>\n\n\n\n

Au stade de d\u00e9but de la maladie4<\/sup><\/h2>\n\n\n\n
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Au stade avanc\u00e9 de la maladie<\/strong>4<\/sup><\/h2>\n\n\n\n
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Illustration : EVER Pharma<\/figcaption><\/figure>\n<\/div><\/div>\n\n\n\n
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Guidelines<\/h2>\n<\/div><\/div>\n\n\n\n
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HAS (2016). Guide du parcours de soins – Maladie de Parkinson <\/h2>\n\n\n\n
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aller sur le site<\/a><\/div>\n<\/div>\n<\/div>\n<\/div>\n\n\n\n
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HAS (2016). Maladie de Parkinson et syndromes apparent\u00e9s : <\/h2>\n\n\n\n

techniques et modalit\u00e9s de la prise en charge non m\u00e9dicamenteuse des troubles moteurs<\/p>\n\n\n\n

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ALLer sur le site<\/a><\/div>\n<\/div>\n<\/div>\n<\/div>\n<\/div><\/div>\n\n\n\n
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Gamme D-mine<\/em>\u00ae<\/sup><\/span>
(partie promotionnelle) <\/h2>\n\n\n\n
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En savoir plus<\/a><\/div>\n<\/div>\n<\/div>\n<\/div>\n<\/div>\n\n\n\n
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A propos du Dopaceptin\u00ae<\/strong> <\/sup>
(partie promotionnelle)<\/h2>\n\n\n\n

En savoir plus sur le Dopaceptin\u00ae<\/sup> et les donn\u00e9es de s\u00e9curit\u00e9.<\/p>\n<\/div>\n\n\n\n

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EN SAVOIR PLUS<\/a><\/div>\n<\/div>\n<\/div>\n<\/div>\n<\/div>\n<\/div>\n<\/div><\/div>\n\n\n\n
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Sources : <\/h2>\n\n\n\n

1<\/sup>Pahwa, R., & Lyons, K. E. (2010). Early diagnosis of Parkinson’s disease: recommendations from diagnostic clinical guidelines. The American journal of managed care<\/em>, 16 Suppl Implications<\/em>, S94\u2013S99.<\/p>\n\n\n\n

2<\/sup>Olanow, C.W., & Agid, Y. (2002). Levodopa: Why the Controversy? Medscape<\/em>. <\/p>\n\n\n\n

3<\/sup>Nutt, J. G., Obeso, J. A., & Stocchi, F. (2000). Continuous dopamine-receptor stimulation in advanced Parkinson’s disease. Trends in neurosciences, 23(10 Suppl)<\/em>, S109\u2013S115. https:\/\/doi.org\/10.1016\/s1471-1931(00)00029-x <\/p>\n\n\n\n

4<\/sup>Guide du parcours de soins \u2013 Maladie de Parkinson. Haute Autorit\u00e9 de Sant\u00e9 (HAS), septembre 2016<\/p>\n\n\n\n

5<\/sup>Olanow, C. W., Watts, R. L., & Koller, W. C. (2001). An algorithm (decision tree) for the management of Parkinson’s disease (2001): treatment guidelines. Neurology, 56(11 Suppl 5)<\/em>, S1\u2013S88. https:\/\/doi.org\/10.1212\/wnl.56.suppl_5.s1 <\/p>\n<\/div><\/div>\n","protected":false},"excerpt":{"rendered":"","protected":false},"author":13,"featured_media":0,"parent":0,"menu_order":3,"comment_status":"open","ping_status":"closed","template":"","meta":{"_acf_changed":false,"footnotes":""},"class_list":["post-27","page","type-page","status-publish","hentry"],"acf":[],"yoast_head":"\nMaladie de Parkinson - D-Mine\u00ae Care France<\/title>\n<meta name=\"description\" content=\"Everything about the diagnosis of Parkinson's disease, the symptoms and the progression. 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