Pharmacotherapy for Parkinson's disease
Pharmacotherapy for Parkinson's disease
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DOI：
10.1592/phco.27.12part2.161s
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发表时间：
2007-12-01
期刊：
影响因子：
4.1
通讯作者：
Swope, David M.
中科院分区：
文献类型：
--
作者：
Chen, Jack J.;Swope, David M.
帕金森病的现有药物治疗解决了神经病学问题，因为没有药物被证明可以提供明确的神经保护作用。药物治疗的选择必须考虑短期利益以及长期后果。轻度帕金森病患者通常无需对症治疗即可充分发挥功能。然而，最近的数据表明，用耐受性良好的药物（例如，单胺氧化酶[MAO]-B抑制剂雷沙吉兰）与改善的长期结果相关。还应考虑许多患者特定的因素，包括患者的期望，残疾程度，就业状况，功能以及实足年龄，药物的预期疗效和耐受性，以及对既往帕金森病治疗的反应。最初的单药治疗开始于非多巴胺能药物，或者如果患者被认为是功能年轻的，则开始于多巴胺受体激动剂。由于帕金森病是一种进行性疾病，药物治疗的调整必须随着时间的推移而进行。当需要更大的症状缓解时，或在更虚弱的老年患者中，应考虑左旋多巴治疗。如果出现运动波动，应考虑添加儿茶酚-O-甲基转移酶抑制剂或MAO-B抑制剂。对于左旋多巴诱导的运动障碍的管理，添加金刚烷胺是一种选择。当患者需要额外的症状控制或尽管进行了优化治疗但仍出现严重运动并发症时，可考虑手术。
The available pharmacotherapies for Parkinson's disease address symptomatology because no agent has been demonstrated to provide definite neuroprotection against the disease. Choice of pharmacotherapy must include consideration of short-term benefits as well as long-term consequences. Patients with mild Parkinson's disease often function adequately without symptomatic treatment. However, recent data suggest that initiation of treatment with a well-tolerated agent (e.g., the monoamine oxidase [MAO]-B inhibitor rasagiline) in the absence of functional impairment is associated with improved long-term outcomes. Consideration should also be given to many patient-specific factors, including patient expectations, level of disability, employment status, functional as well as chronologic age, expected efficacy and tolerability of drugs, and response to previous Parkinson's disease therapies. Increasingly, initial monotherapy begins with a nondopaminergic agent or, if the patient is considered functionally young, a dopamine agonist. Since Parkinson's disease is a progressive disorder, adjustments to pharmacotherapy must be expected over time. When greater symptomatic relief is desired, or in the more frail elderly patient, levodopa therapy should be considered. if motor fluctuations develop, addition of a catechol-O-methyltransferase inhibitor or MAO-B inhibitor should be considered. For management of levodopa-induced dyskinesias, addition of amantadine is an option. Surgery may be considered when patients need additional symptomatic control or are experiencing severe motor complications despite pharmacologically optimized therapy.