Hely M A, Fung V S, Morris J G
Department of Neurology, Westmead Hospital, Westmead, NSW, 2145, Australia.
J Clin Neurosci. 2000 Nov;7(6):484-94. doi: 10.1054/jocn.2000.0766.
The aim of current treatment of Parkinson's disease is to ameliorate the symptoms while seeking to lessen the potential development of late levodopa complications. To this end, there is ample evidence that the early use of dopamine agonists is beneficial in younger Parkinsonian patients but monotherapy with dopamine agonists is for only a select few. Nonergot dopamine agonists offer the potential for fewer side effects. Lower dose levodopa therapy delays the onset and reduces severity of dyskinesia and end of dose failure. However levodopa remains the treatment of choice in Parkinson's disease and should not be restricted unnecessarily in patients with disability. There is no evidence that levodopa is toxic to dopaminergic neurons in people with Parkinson's disease. As yet, no drugs are of proven neuroprotective value. Dopamine agonists, catechol-o-methyltransferase inhibitors, amantadine and apomorphine have differing but beneficial roles in the management of levodopa side effects. Ablative surgery and deep brain stimulation of thalamus, globus pallidus and subthalamic nucleus are increasingly available but choice of procedure depends not just on patient symptomatology, but also on local experience and results. Ideally, deep brain stimulation is the treatment of choice as it offers less morbidity than bilateral ablative surgery, the possibility of postoperative adjustments and the potential for reversibility if better treatments become available.
当前帕金森病治疗的目标是缓解症状，同时力求减少左旋多巴晚期并发症的潜在发生。为此，有充分证据表明，早期使用多巴胺激动剂对年轻帕金森病患者有益，但仅少数患者可采用多巴胺激动剂单药治疗。非麦角类多巴胺激动剂副作用可能较少。较低剂量的左旋多巴治疗可延迟异动症的发生并减轻其严重程度，还可缓解剂末失效。然而，左旋多巴仍是帕金森病的首选治疗药物，对于有残疾的患者不应不必要地限制使用。没有证据表明左旋多巴对帕金森病患者的多巴胺能神经元有毒性。目前，尚无经证实具有神经保护作用的药物。多巴胺激动剂、儿茶酚-O-甲基转移酶抑制剂、金刚烷胺和阿扑吗啡在处理左旋多巴副作用方面具有不同但有益的作用。毁损性手术以及对丘脑、苍白球和丘脑底核进行深部脑刺激的方法越来越多，但手术方式的选择不仅取决于患者的症状，还取决于当地的经验和效果。理想情况下，深部脑刺激是首选治疗方法，因为与双侧毁损性手术相比，它的发病率更低，术后有可能进行调整，而且如果有更好的治疗方法，还具有可逆性的潜力。
