Mendis T, Suchowersky O, Lang A, Gauthier S
University of Ottawa, Ottawa Civic Hospital, SCO Hospitals, ON.
Can J Neurol Sci. 1999 May;26(2):89-103.
The management of Parkinson's disease has undergone recent changes with the advent of new therapies, both pharmacotherapy and surgery. Available interventions are discussed. Levodopa remains the mainstay of therapy. New drugs include the dopamine agonists and COMT inhibitors. New dopamine agonists which may have a levodopa "sparing effect;" it has been suggested that some of the drugs should be considered as first line treatments for newly diagnosed Parkinson's disease patients. We review roles of these drugs. The concept of neuroprotection in neurodegenerative disorders such as Parkinson's disease became popular in the mid 1980s and it is hoped that eventually therapy will be directed at slowing progression of the disease. A great deal more work needs to be done before a suitable agent is identified as being neuroprotective. Potential neuroprotective agents are reviewed. Surgical therapies for Parkinson's disease consisting of various forms of lesion surgery as well as stimulation procedures are reviewed. Complications of drug therapy include motor problems such as motor response fluctuations, as well as psychiatric complications including levodopa-induced psychosis. Atypical neuroleptic agents and ECT for psychiatric syndromes associated with Parkinson's disease are discussed. Algorithms for the management of early disease as well as the management of psychosis in Parkinson's disease are included. Treatment options for advanced disease are tabulated.
随着新疗法（包括药物治疗和手术治疗）的出现，帕金森病的管理最近发生了变化。文中讨论了现有的干预措施。左旋多巴仍然是治疗的主要手段。新药包括多巴胺激动剂和儿茶酚-O-甲基转移酶（COMT）抑制剂。新的多巴胺激动剂可能具有左旋多巴“节省效应”；有人建议，其中一些药物应被视为新诊断帕金森病患者的一线治疗药物。我们回顾了这些药物的作用。神经保护在帕金森病等神经退行性疾病中的概念在20世纪80年代中期开始流行，人们希望最终治疗将针对减缓疾病进展。在确定一种合适的神经保护剂之前，还需要做大量的工作。文中回顾了潜在的神经保护剂。文中回顾了帕金森病的手术治疗，包括各种形式的毁损手术以及刺激手术。药物治疗的并发症包括运动问题，如运动反应波动，以及精神并发症，包括左旋多巴诱发的精神病。文中讨论了用于帕金森病相关精神综合征的非典型抗精神病药物和电休克治疗（ECT）。文中还包括帕金森病早期管理以及精神病管理的算法。列出了晚期疾病的治疗选择。
