{"id":5665,"date":"2025-06-11T07:29:44","date_gmt":"2025-06-11T05:29:44","guid":{"rendered":"https:\/\/kineaphp.fr\/?p=5665"},"modified":"2026-01-06T15:47:16","modified_gmt":"2026-01-06T14:47:16","slug":"le-patient-atteint-de-la-maladie-de-parkinson","status":"publish","type":"post","link":"https:\/\/kineaphp.fr\/?p=5665","title":{"rendered":"La maladie de Parkinson : signes cliniques et troubles associ\u00e9s"},"content":{"rendered":"\n<h2 id=\"triade-clinique-de-la-mpi\" class=\"wp-block-heading\">Triade clinique de la MPI<\/h2>\n\n\n\n<ul class=\"wp-block-list\">\n<li><strong>Tremblement de repos<\/strong> : mouvement oscillatoire de faible amplitude, de rythme lent (4 \u00e0 6 cycles par secondes), qui pr\u00e9domine aux extr\u00e9mit\u00e9s<\/li>\n\n\n\n<li><strong>Akin\u00e9sie <\/strong>: perte ou trouble de l&rsquo;initiation et de l&rsquo;ex\u00e9cution du mouvement par perte de l&rsquo;initiative motrice, de la spontan\u00e9it\u00e9 des mouvements, avec lenteur des mouvements<\/li>\n\n\n\n<li><strong>Hypertonie extrapyramidale<\/strong> (hypertonie plastique : en \u00ab\u00a0tuyau de plomb\u00a0\u00bb ou \u00ab\u00a0en roue dent\u00e9e\u00a0\u00bb<\/li>\n<\/ul>\n\n\n\n<h2 id=\"signes-associes-a-la-triade\" class=\"wp-block-heading\">Signes associ\u00e9s \u00e0 la triade<\/h2>\n\n\n\n<p>Ils apparaissent au fur et \u00e0 mesure de l&rsquo;\u00e9volution de la MPI :<\/p>\n\n\n\n<ul class=\"wp-block-list\">\n<li><strong>Troubles de la posture <\/strong>: troubles de l&rsquo;orientation et troubles de l&rsquo;\u00e9quilibration, troubles de la coordination posture-mouvement<\/li>\n\n\n\n<li><strong>Troubles de la parole et de la d\u00e9glutition<\/strong> : voix monocorde, palilalie (r\u00e9p\u00e9tition de phon\u00e8mes), tachyph\u00e9mie paroxystique (se remettre \u00e0 parler avec une extr\u00eame rapidit\u00e9)<\/li>\n\n\n\n<li><strong>Signes neurov\u00e9g\u00e9tatifs <\/strong>qui associent :\n<ul class=\"wp-block-list\">\n<li>troubles digestifs tr\u00e8s fr\u00e9quents (constipation)<\/li>\n\n\n\n<li>hypotension art\u00e9rielle orthostatique<\/li>\n\n\n\n<li>troubles v\u00e9sicosphinct\u00e9riens<\/li>\n\n\n\n<li>amaigrissement (asp\u00e9cifique)<\/li>\n<\/ul>\n<\/li>\n\n\n\n<li><strong>Troubles sensitifs<\/strong> \u00e0 type de crampes, engourdissement, sensation de chaleur, etc<\/li>\n\n\n\n<li><strong>Troubles du sommeil et de la vigilance<\/strong>\n<ul class=\"wp-block-list\">\n<li>\u00e0 type d&rsquo;insomnie initiale ou concernant la deuxi\u00e8me partie de la nuit<\/li>\n\n\n\n<li>\u00e0 type de cauchemars qui correspondent \u00e0 des troubles du comportement en sommeil paradoxal<\/li>\n<\/ul>\n<\/li>\n\n\n\n<li><strong>Troubles cognitifs et psychiques<\/strong>\n<ul class=\"wp-block-list\">\n<li>troubles de l&rsquo;attention et des fonctions ex\u00e9cutives<\/li>\n\n\n\n<li>troubles de la m\u00e9moire \u00e0 court terme, li\u00e9s \u00e0 la difficult\u00e9 du contr\u00f4le attentionnel<\/li>\n\n\n\n<li>bradypsychie (ralentissement dans le temps de r\u00e9ponse)<\/li>\n\n\n\n<li>d\u00e9pression et anxi\u00e9t\u00e9<\/li>\n\n\n\n<li>d\u00e9mence<\/li>\n<\/ul>\n<\/li>\n<\/ul>\n\n\n\n<h2 id=\"traitement-a-la-ldopa\" class=\"wp-block-heading\">Traitement \u00e0 la L-Dopa<\/h2>\n\n\n\n<p>Complications motrices li\u00e9es au traitement<\/p>\n\n\n\n<ul class=\"wp-block-list\">\n<li>Premi\u00e8re phase : \u00ab\u00a0lune de miel\u00a0\u00bb, dure entre 1 et 10 ans, g\u00eane motrice mod\u00e9r\u00e9e<\/li>\n\n\n\n<li>Deuxi\u00e8me phase : peut durer 20 ans, marqu\u00e9e par des fluctuations : akin\u00e9sie de fin de dose qui deviennent de plus en plus marqu\u00e9es (effets \u00ab\u00a0on-off\u00a0\u00bb), dyskin\u00e9sies de milieu de dose. <\/li>\n\n\n\n<li>Troisi\u00e8me phase : perte d&rsquo;efficacit\u00e9 de la L-Dopa<\/li>\n<\/ul>\n\n\n\n<h2 id=\"echelles-devaluation\" class=\"wp-block-heading\">Echelles d&rsquo;\u00e9valuation<\/h2>\n\n\n\n<h3 id=\"echelle-de-hoen-et-yahr\" class=\"wp-block-heading\">Echelle de Hoen et Yahr<\/h3>\n\n\n\n<ul class=\"wp-block-list\">\n<li>Stade 1 : atteinte unilat\u00e9rale avec handicap fonctionnel habituellement minime ou nul<\/li>\n\n\n\n<li>Stade 2 : atteinte bilat\u00e9rale ou axiale sans alt\u00e9ration de l&rsquo;\u00e9quilibre<\/li>\n\n\n\n<li>Stade 3 : apparition d&rsquo;une alt\u00e9ration de l&rsquo;\u00e9quilibre, mise en \u00e9vidence lorsque le malade change de direction ou lorsqu&rsquo;on le pousse alors qu&rsquo;il se tient debout, pieds joints et yeux ferm\u00e9s.<br>A ce stade, il pr\u00e9sente une v\u00e9ritable g\u00eane fonctionnelle dans ses activit\u00e9s mais peut poursuivre son travail (selon le type d&#8217;emploi)<\/li>\n\n\n\n<li>Stade 4 : d\u00e9veloppement complet de la maladie qui entra\u00eene une incapacit\u00e9 s\u00e9v\u00e8re. Le malade peut encore se tenir debout et marcher sans aide mais avec de grandes difficult\u00e9s<\/li>\n\n\n\n<li>Stade 5 : le malade ne peut se d\u00e9placer qu&rsquo;en fauteuil roulant ou est grabataire<\/li>\n<\/ul>\n\n\n\n<h3 id=\"classification-de-bleton-et-ziegler\" class=\"wp-block-heading\">Classification de Bleton et Ziegler<\/h3>\n\n\n\n<ul class=\"wp-block-list\">\n<li>Stade 1 : vie presque normale ; c&rsquo;est la phase de lune de miel<\/li>\n\n\n\n<li>Stade 2 : maladie install\u00e9e avec g\u00eane motrice, d\u00e9placements limit\u00e9s avec fluctuation on\/off<\/li>\n\n\n\n<li>Stade 3 : handicap majeur avec marche tr\u00e8s difficile, gestes rares. Il y a accoutumance au traitement<\/li>\n<\/ul>\n\n\n\n<h3 id=\"les-6-sections-de-lechelle-updrs\" class=\"wp-block-heading\">Les 6 sections de l&rsquo;\u00e9chelle UPDRS<\/h3>\n\n\n\n<ul class=\"wp-block-list\">\n<li>1 &#8211; Etat mental, comportemental et thymique<\/li>\n\n\n\n<li>2 &#8211; Activit\u00e9s de la vie quotidienne (on\/off)<\/li>\n\n\n\n<li>3 &#8211; Examen moteur (on\/off)<\/li>\n\n\n\n<li>4 &#8211; Complication du traitement (dyskin\u00e9sies, fluctuations, dysautonomie)<\/li>\n\n\n\n<li>5 &#8211; Stades de Hoehn et Yahr<\/li>\n\n\n\n<li>6 &#8211; Echelle de Schwab et England<\/li>\n<\/ul>\n\n\n\n<h2 id=\"les-retentissements-fonctionnels-de-la-mpi\" class=\"wp-block-heading\">Les retentissements fonctionnels de la MPI<\/h2>\n\n\n\n<ul class=\"wp-block-list\">\n<li>Atteinte de la fonction posturale<\/li>\n\n\n\n<li>Atteinte de la fonction gestuelle<\/li>\n\n\n\n<li>Atteinte buccofaciale<\/li>\n\n\n\n<li>Atteinte occulo-motrice<\/li>\n\n\n\n<li>Douleurs articulaires et musculaires<\/li>\n\n\n\n<li>Troubles psychiques<\/li>\n\n\n\n<li>troubles urinaires<\/li>\n\n\n\n<li>Troubles du sommeil<\/li>\n\n\n\n<li>Troubles digestifs<\/li>\n<\/ul>\n\n\n\n<h2 id=\"observation-morphostatique\" class=\"wp-block-heading\">Observation morphostatique<\/h2>\n\n\n\n<p>Les principales d\u00e9formations conduisant \u00e0 l&rsquo;attitude spontan\u00e9e fig\u00e9e sont :<\/p>\n\n\n\n<ul class=\"wp-block-list\">\n<li>la cyphose dorsale<\/li>\n\n\n\n<li>l&rsquo;hyperlordose cervicale, compens\u00e9e par la projection de la t\u00eate vers l&rsquo;avant<\/li>\n\n\n\n<li>la scoliose parkinsonienne avec la t\u00eate plus souvent pench\u00e9e du m\u00eame c\u00f4t\u00e9 que le tronc<\/li>\n\n\n\n<li>l&rsquo;enroulement des \u00e9paules<\/li>\n\n\n\n<li>les flexums de hanches et de genoux<\/li>\n<\/ul>\n\n\n\n<h2 id=\"troubles-associes\" class=\"wp-block-heading\">Troubles associ\u00e9s<\/h2>\n\n\n\n<ul class=\"wp-block-list\">\n<li>Troubles du sommeil \u00e0 type d&rsquo;insomnie<\/li>\n\n\n\n<li>Troubles de la communication<\/li>\n\n\n\n<li>Dysgraphisme ou micrographie<\/li>\n\n\n\n<li>Troubles de la fonction oculomotrice<\/li>\n\n\n\n<li>Hypotension orthostatique<\/li>\n\n\n\n<li>Hypers\u00e9cr\u00e9tion cutan\u00e9e et s\u00e9bac\u00e9e<\/li>\n\n\n\n<li>Hyper-sudation<\/li>\n\n\n\n<li>S\u00e9cheresse de la bouche<\/li>\n\n\n\n<li>Hyper-salivation<\/li>\n\n\n\n<li>Troubles urinaires<\/li>\n\n\n\n<li>Constipation du fait du traitement m\u00e9dical<\/li>\n<\/ul>\n","protected":false},"excerpt":{"rendered":"<p>Triade clinique de la MPI Signes associ\u00e9s \u00e0 la triade Ils apparaissent au fur et \u00e0 mesure de l&rsquo;\u00e9volution de la MPI : Traitement \u00e0 la L-Dopa Complications motrices li\u00e9es au traitement Echelles d&rsquo;\u00e9valuation Echelle&hellip;<\/p>\n<p class=\"more-link-wrapper\"><a href=\"https:\/\/kineaphp.fr\/?p=5665\" class=\"more-link\">Continue Reading<span class=\"screen-reader-text\"> \u00ab\u00a0La maladie de Parkinson : signes cliniques et troubles associ\u00e9s\u00a0\u00bb<\/span><\/a><\/p>\n","protected":false},"author":1,"featured_media":0,"comment_status":"closed","ping_status":"closed","sticky":false,"template":"","format":"standard","meta":{"footnotes":""},"categories":[404],"tags":[],"class_list":["post-5665","post","type-post","status-publish","format-standard","hentry","category-champ-neuro-maladie-de-parkinson"],"yoast_head":"<!-- This site is optimized with the Yoast SEO plugin v25.7 - 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