The therapeutic approach of motor fluctuations is based on the need for recognizing various types of motor fluctuations for each patient by a meticulous interrogation and also to have a good knowledge of the pharmacology of the various anti-parkinsonian drugs. The treatment of the morning akinesia is linked to the use of anti-parkinsonian drugs with fast action like levodopa in dispersible formulation or apomorphine. The levodopa formulations with prolonged release can be proposed in the treatment of the noctural akinesia. "End of dose" and "on-off" fluctuations require a stable dopaminergic stimulation. It requires the use of drug associations which, for the majority, were never validated by rigorous therapeutic studies. Severe motor fluctuations require the use of apomorphine or chronic stimulation of the subthalamic nucleus.