Approches thérapeutiques pour rétablir l'homéostasie de la dopamine et soulager les symptômes moteurs dans la maladie de Parkinson – une revue narrative
DOI :
https://doi.org/10.18192/osurj.v4i1.7376Résumé
La maladie de Parkinson (MP) est la deuxième maladie neurodégénérative la plus fréquente. Elle se caractérise par une perte progressive de neurones dopaminergiques dans la substantia nigra pars compacta, entraînant des troubles moteurs tels que bradykinésie, tremblements et rigidité. Les stratégies thérapeutiques actuelles visent à rétablir l'homéostasie de la dopamine et à atténuer les symptômes moteurs par des interventions pharmacologiques, chirurgicales et non pharmacologiques. Cette revue narrative met en lumière trois approches pharmacologiques principales : (1) la substitution de la dopamine par la lévodopa, le traitement de référence, qui est efficace mais associé à des complications à long terme telles que les fluctuations motrices et les dyskinésies ; (2) les agonistes des récepteurs de la dopamine, qui offrent une alternative à la lévodopa mais présentent davantage d'effets secondaires non moteurs ; et (3) les inhibiteurs des enzymes de dégradation de la dopamine, y compris les inhibiteurs de la monoamine oxydase B (MAO-B) et de la catéchol-O-méthyltransférase (COMT), qui prolongent la disponibilité de la dopamine et réduisent les fluctuations motrices. Les stratégies émergentes se concentrent sur des composés multifonctionnels ciblant à la fois la MAO-B et la COMT, offrant une neuroprotection et une meilleure stabilité dopaminergique. Malgré les progrès réalisés dans la prise en charge de la MP, il reste un besoin urgent de nouvelles thérapeutiques qui soulagent durablement les symptômes avec un minimum d'effets secondaires.
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