Rascol O, Ferreira J J, Payoux P, Brefel-Courbon Ch, Montastruc J L
Service de Pharmacologie, Faculté de Médecine, Centre d'Investigations Cliniques, INSERM U455, 37, Allées Jules-Guesde, 31073 Toulouse, France.
Rev Neurol (Paris). 2002 Dec;158 Spec no 1:S117-24.
There are three main therapeutic strategies to manage levodopa-induced dyskinesias in parkinsonian patients: (1) prevent the occurrence of the priming phenomenon which generates the abnormal movements, (2) avoid the expression of dyskinesias in already primed brain with antidyskinetic symptomatic interventions and (3) reverse, once primed, the changes that occurred in the basal ganglia to induce dyskinesias. To prevent, at least partly, priming for dyskinesias is attempted by the early use of dopamine D2 agonists, which delays the need for levodopa. To avoid the expression of dyskinesias in already primed patients, amantadine is presently the most efficacious symptomatic medication, while functional stereotactic surgery is required in the most severe cases. There are several ways to try to reverse, at least partly, dyskinesia priming. The strategy is to reduce as much as possible (ideally completely) the daily dose of levodopa, by the mean of adjunct interventions like high doses of oral agonists, or more efficiently, with apormorphine subcutaneous infusion or subthalamic deep brain stimulation.
帕金森病患者中，治疗左旋多巴诱导的运动障碍主要有三种策略：（1）防止引发异常运动的启动现象的发生；（2）通过抗运动障碍的对症干预措施，避免已启动的大脑中运动障碍的表现；（3）一旦启动，逆转基底神经节中发生的导致运动障碍的变化。为了至少部分地防止运动障碍的启动，人们尝试通过早期使用多巴胺D2激动剂来实现，这会延迟左旋多巴的使用需求。为了避免已启动患者出现运动障碍的表现，金刚烷胺目前是最有效的对症药物，而在最严重的病例中则需要进行功能性立体定向手术。有几种方法可以尝试至少部分地逆转运动障碍启动。策略是通过高剂量口服激动剂等辅助干预手段，或者更有效地通过阿扑吗啡皮下输注或丘脑底核深部脑刺激，尽可能（理想情况下完全）减少左旋多巴的每日剂量。
