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Stages of Parkinson's Disease

Updated: Apr 26

The evolution of Parkinson's disease is essentially defined at the clinical level according to the appearance of certain characteristic symptoms. It is different according to individuals, their environment and the treatment set up by specialists.

The different stages of the disease can be correlated with the evolution of neuron degeneration at the central level. In 2002, Braak's team proposed a vision of the degeneration's evolution, starting with the digestive and olfactory system and extending to a large number of cerebral structures.

Stage 0: Prodromal phase

This first phase represents all the symptoms that may appear before Parkinson's disease, it is not in itself a first phase of the disease but rather its warning signs.

Stage 1: Beginning of the pathology

It is usually during this period that the disease will be diagnosed and a first treatment will be proposed. We find the triad characteristic of Parkinson's syndrome, i.e. bradykinesia (slow movement), rest tremor and muscle stiffness.

Stage 2: Stabilization

This is the so-called therapeutic balance or "honeymoon" phase. The treatment used makes it possible to overcome the vast majority of symptoms and the disease no longer has an impact on the patient's daily life. This phase can last from 2 to 6 years on average. It is important to note that during this phase, the disease continues to progress, the drugs used do not stop the progression of the disease but only temporarily alleviate the symptoms.

Stage 3: Therapeutic escape

The effectiveness of the treatment will decrease and the motor symptoms will reappear.

We will see motor fluctuations occurring during the day and breaking down into 3 parts:

The OFF phenomenon : the treatment is no longer effective, the motor symptoms are severe and the patient's autonomy is strongly affected.

The ON phenomenon: the treatment is effective, the patient can move correctly, most of the symptoms are reduced.

The over-ON or dyskinetic phase: the dopamine concentration at the central level is too high, resulting in a too high motor activation. This activity results in the development of dyskinesias, defined as sudden and involuntary movements of the patient.

It is sometimes possible that the disability generated by dyskinesia is more important than the symptoms of the pathology. This is why some treatments are specifically indicated to reduce this side effect. A therapeutic rebalancing will also be considered.

Stage 4: Late phase

Neural degeneration will spread and new symptoms will appear such as axial or cognitive disorders. Generally, these signs will appear after 10 years of disease progression, but there are of course many exceptions.

Dependency gradually sets in as the severity of motor symptoms increases.

Throughout the progression of the disease, regular visits to the neurologist (approximately every 6 months) allow a regular review of the treatment and the selection of specialists adapted according to the symptoms mentioned.

To limit walking disorders and freezing related to the pathology, solutions have been developed. The WALK now makes it possible to lighten your walking and improve your daily autonomy.

To discover a neurological rehabilitation method used to reduce motor disorders in Parkinson's disease, click here 👇

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