Stocchi Fabrizio
IRCCS NEUROMED Pozzilli (15), Institute of Neuroscience, Viale dell'Università 30, 00185 Rome, Italy.
Parkinsonism Relat Disord. 2003 Aug;9 Suppl 2:S73-81. doi: 10.1016/s1353-8020(03)00021-x.
The symptoms of Parkinson's disease can become increasingly difficult to control as the disease advances, particularly with the development of motor complications, such as end-of-dose wearing-off and dyskinesias, following long-term therapy. At this stage, the patient is frequently referred to a Parkinson's disease specialist for advice on the management of their disease. In this review we provide an overview of the Parkinson's disease specialist's strategies for coping with such problems. This includes strategy to prevent or delay motor fluctuations and the concept of the long duration response. The paper also includes establishing the optimum and most rational levodopa treatment schedule, improving levodopa absorption, use of COMT-inhibition, the addition of oral dopaminergic agonists, and the use of subcutaneous injections or infusions of apomorphine or lisuride. Finally, we highlight the increasing importance of treatment strategies that stimulate dopamine receptors in a more continuous, less pulsatile manner as a way of reducing the risk of developing treatment-associated motor complications.
随着帕金森病的进展，其症状会越来越难以控制，尤其是在长期治疗后出现运动并发症，如剂末疗效减退和异动症时。在这个阶段，患者经常会被转介给帕金森病专家，以获取有关疾病管理的建议。在这篇综述中，我们概述了帕金森病专家应对此类问题的策略。这包括预防或延迟运动波动的策略以及长期反应的概念。本文还包括制定最佳且最合理的左旋多巴治疗方案、改善左旋多巴吸收、使用儿茶酚-O-甲基转移酶（COMT）抑制剂、添加口服多巴胺能激动剂以及使用阿扑吗啡或利苏瑞肽的皮下注射或输注。最后，我们强调以更持续、更少脉冲式的方式刺激多巴胺受体的治疗策略对于降低发生与治疗相关的运动并发症风险的重要性日益增加。
