Djaldetti Ruth, Melamed Eldad
Chairman Department of Neurology, Rabin Medical Center, Beilinson Campus, 49100 Petach-Tiqva, Israel.
J Neurol. 2002 Sep;249 Suppl 2:II30-5. doi: 10.1007/s00415-002-1206-2.
During the last few decades, there has been a remarkable progress in our understanding of the biology of Parkinson's disease (PD), which has been translated into the development of numerous antiparkinsonian drugs. There are different therapeutic strategies for patients in an early stage versus patients in a late stage of the disease. The current therapeutic arsenal includes levodopa preparations, MAO-B inhibitors, dopamine agonists, COMT inhibitors and several other compounds that target non-dopaminergic systems. Much interest is focused on the potential neuroprotective effect of the already available drugs, as well as on new research approaches for the development of disease-modifying agents. These include mainly anti-glutamategic compounds, anti-apoptotic and antioxidative agents. Future therapy might include targeted delivery of trophic factors or genes involved in the pathogenesis of the disease. Apart from the classic levodopa-associated motor complications, such as dyskinesias and response fluctuations and psychosis, many other problems of advanced disease should be focused upon and solved including fatigue, freezing of gait, postural instability, depression, anxiety and panic attacks, sleep disturbances, autonomic dysfunction and sensory complaints.
在过去几十年里，我们对帕金森病（PD）生物学的理解取得了显著进展，这已转化为众多抗帕金森病药物的研发。对于疾病早期患者和晚期患者有不同的治疗策略。目前的治疗手段包括左旋多巴制剂、单胺氧化酶B（MAO-B）抑制剂、多巴胺激动剂、儿茶酚-O-甲基转移酶（COMT）抑制剂以及其他几种针对非多巴胺能系统的化合物。人们对现有药物潜在的神经保护作用以及开发疾病修饰剂的新研究方法极为关注。这些主要包括抗谷氨酸能化合物、抗凋亡和抗氧化剂。未来的治疗可能包括靶向递送与疾病发病机制相关的营养因子或基因。除了经典的左旋多巴相关运动并发症，如运动障碍、反应波动和精神病外，还应关注并解决晚期疾病的许多其他问题，包括疲劳、步态冻结、姿势不稳、抑郁、焦虑和惊恐发作、睡眠障碍、自主神经功能障碍和感觉障碍。
