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Parkinson’s disease is progressive neurodegenerative disease that affects approximately 4,5-16/100.000 persons/year in occidental countries. It is characterized by tremors, maximal at rest, retropulsion, rigidity, inclined posture, slowness of voluntary movements and facial expression similar to a mask. Since the cause of the disease has not yet been elucidated, therapeutic management is not curative, it is currently oriented towards the symptoms of the disease. Of all the therapeutic arsenal, L-Dopa is the most effective treatment but in most cases must be combined with other drugs. Unfortunately, involuntary and disabling abnormal motor movements appear in approximately 40% of patients treated with L-Dopa after about 4 to 6 years. Among the classes of drugs used to treat these motor fluctuations are inhibitors of COMT (tolcapone and entacapone) which increase the half-time of L-Dopa by preventing its metabolism in the periphery and in the brain. Tolcapone is more effective than entacapone but unfortunately it has been the cause of severe hepatotoxicity, which has resulted in withdrawal from the market before being reintroduced into the market for limited use. Tolcapone has been the subject of numerous studies to evaluate its safety (its toxicity) but also its effectiveness. A study showed that tolcapone increases the half-life of L-Dopa by 80% compared to 40% for entacapone. Tolcapone has very interesting properties, particularly its ability to pass the blood-brain barrier, allowing it to act both in the periphery and in the brain. Despite its proven hepatic toxicity, various studies have shown that the limited use of tolcapone makes it possible to greatly limit its toxicity. The public health authorities have decided to maintain tolcapone because until now there are no drug alternatives with the same therapeutic properties. But studies using tolcapone as a synthesis model are underway in order to develop non-toxic alternatives. La maladie de Parkinson est une maladie neurodégénérative progressive qui touche environ 4,5-16/100000 personnes/an dans nos pays occidentaux. Elle est caractérisée par les tremblements, maximaux au repos, une rétropulsion, une rigidité, une posture inclinée, une lenteur des mouvements volontaires et une expression faciale semblable à un masque. La cause de la maladie n'étant pas encore élucidée, la prise en charge thérapeutique n'as pas de visée curative, elle est actuellement orientée vers les symptômes de la maladie. De tout l'arsenal thérapeutique, la L-Dopa est le traitement le plus efficace mais qui dans la plupart des cas doit être associée à d'autres médicaments. Mais malheureusement les mouvements anormaux (fluctuations motrices) involontaires et handicapants apparaissent chez environ 40% des patients traités par la L-Dopa après 4 à 6 années environ. Parmi les classes de médicaments utilisées pour traiter ces fluctuations motrices, on retrouve les inhibiteurs de la COMT (tolcapone et entacapone) qui permettent d'augmenter le temps de demi-vie de la L-Dopa en empêchant sa métabolisation en périphérie et dans le cerveau. La tolcapone est plus efficace que l'entacapone mais malheureusement, elle a été à l'origine des hépatotoxicités sévères, ce qui lui a valu d'être retirée du marché avant d'être réintroduite sur le marché pour une utilisation limitée. La tolcapone a fait l'objet de nombreuses études pour évaluer sa sécurité (sa toxicité) mais aussi son efficacité. Une étude a notamment montré que la tolcapone augmente le temps de demi-vie de la L-Dopa de 80% contre 40% pour l'entacapone. La tolcapone possède les propriétés très intéressantes notamment sa capacité à passer la barrière hémato-encéphalique, ce qui lui permet d'agir à la fois en périphérie et au niveau du cerveau. Malgré sa toxicité hépatique avérée, diverses études ont montré que l'utilisation restreinte de la tolcapone permettait de limiter fortement sa toxicité. Les autorités s'occupant de la santé publique ont décidé de maintenir la tolcapone car jusqu'à maintenant il n'existe pas d'alternatives médicamenteuses ayant les mêmes propriétés thérapeutiques. Mais les études utilisant la tolcapone comme modèle de synthèses sont en cours afin de développer les alternatifs non toxiques.

tolcapone --- Antiparkinson Agents --- Parkinson Disease

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Antiparkinsonian agents --- Parkinson's disease --- Antiparkinson Agents --- Antiparkinson Agents --- Parkinson Disease --- Parkinson Disease --- Treatment --- adverse effects --- therapeutic use --- diagnosis --- drug therapy

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Extrapyramidal disorders. --- Parkinson's disease. --- Basal ganglia diseases. --- Parkinson disease. --- Antiparkinson agents.

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Agents antiparkinsoniens --- Antiparkinson middelen --- Antiparkinsonian agents --- Antiparkinson Agents --- Parkinson Disease --- Parkinson's disease --- -Palsy, Shaking --- Paralysis agitans --- Parkinson disease --- Parkinsonism --- Shaking palsy --- Brain --- Extrapyramidal disorders --- Antiparkinson agents --- Antiparkinsonism agents --- Central nervous system depressants --- therapeutic use. --- drug therapy. --- Chemotherapy --- Diseases --- Antiparkinsonian agents. --- Chemotherapy. --- -therapeutic use. --- Therapeutic use. --- Drug therapy. --- therapeutic use --- drug therapy

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Far from celebrity media spotlight, ordinary individuals, many older and less advantaged, suffer the disabling pain of Parkinson's disease (PD), an illness whose progressive symptoms often mimic old age and cause mobility impairment, communication barriers, and social isolation. At the heart of With Shaking Hands is the account of elder Americans in rural Iowa who have been diagnosed with PD. With a focus on the impact of chronic illness on an aging population, Samantha Solimeo combines clear and accessible prose with qualitative and quantitative research to demonstrate how PD accelerates, mediates, and obscures patterns of aging. She explores how ideas of what to expect in older age influence and direct interpretations of one's body. This sensitive and groundbreaking work unites theories of disease with modern conceptions of the body in biological and social terms. PD, like other chronic disorders, presents a special case of embodiment which challenge our thinking about how such diseases should be researched and how they are experienced.

Health Services for the Aged. --- Caregivers --- Antiparkinson Agents. --- Aging --- Aged --- Parkinson Disease --- Medical anthropology. --- Parkinson's disease --- Medical care --- Medicine --- Anthropology --- Elderly --- Geriatrics --- Longevity --- Palsy, Shaking --- Paralysis agitans --- Parkinson disease --- Parkinsonism --- Shaking palsy --- Brain --- Extrapyramidal disorders --- Antiparkinson Drugs --- Antiparkinsonian Agents --- Antiparkinsonians --- Agents, Antiparkinson --- Agents, Antiparkinsonian --- Drugs, Antiparkinson --- Parasympatholytics --- Health Services for Aged --- Health Services for the Elderly --- Health Services, Geriatric --- Geriatric Health Services --- Geriatric Health Service --- Health Service, Geriatric --- Service, Geriatric Health --- Services, Geriatric Health --- Frail Elderly --- psychology. --- Anthropological aspects --- Diseases --- United States.