Parkinson's disease: research for better treatments is booming

The distance was significant, but Marianne (names have been changed) didn't hesitate. Full of hope and expectation, the sixty-year-old traveled to Poitiers with her sister for this medical appointment at the Pitié-Salpêtrière Parkinson's expert center, at the Assistance publique-hôpitaux de Paris (AP-HP), in the ^13th arrondissement. "What I simply want is for my condition to improve a little... I'm willing to try anything!" she says to the neurologist who sees her, Professor David Grabli. Her right arm jerks, her leg too at times, as she tells her story, the progression of her disease since her Parkinson's diagnosis in 2019. At first, it was just a tremor in her middle finger— "that one!" she exclaimed, holding up her right hand. But the situation quickly became very uncomfortable, as the tremor became more widespread.

This symptom—emblematic of Parkinson's disease, yet not systematic—is a component of the "motor triad" that patients present, along with slowness of movement (akinesia) and muscle rigidity, recalls Florence Cormier-Dequaire, neurologist and coordinator of the expert center. These disorders, which occur after an asymptomatic phase lasting several years, are the consequence of the progressive degeneration of dopaminergic neurons in the brain—particularly those in the substantia nigra, a brain region key to coordinating movements. Around 200,000 people in France are being treated for this neurodegenerative disease, the second most common after Alzheimer's. Some 25,000 new cases are diagnosed each year. In the early years, taking levodopa (a dopamine precursor) or dopamine agonists (which mimic its effect) can effectively reduce motor symptoms by compensating for the deficit induced by neuronal loss.

This was the case for Marianne, for nearly six years. “ [But], last February, the situation became unmanageable, my head was no longer holding up, my feet remained stuck to the ground, I could no longer move… I had four falls in five days: I was standing and suddenly, poof, I fell,” she describes. Her neurologist in Poitiers then increased her doses of levodopa, which improved her condition considerably. But the tremors persisted. This is why he referred her to the Pitié-Salpêtrière center, the only one of the 26 French Parkinson’s expert centers to perform – since 2023 – high-intensity focused ultrasound. This technique, which aims to suppress tremors by making small lesions in the thalamus (which neutralizes the overactivation of certain neural circuits at the origin of the tremors), has the advantage of not requiring opening the skull.

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