Maciaczyk Jarosław, Swietaszczyk Cyprian, Kasprzak Heliodor A
Katedra i Klinika Neurochirurgii Neurotraumatologii Akademii Medycznej im Ludwika Rydygiera w Bydgoszczy.
Przegl Lek. 2004;61(12):1383-8.
Parkinson's disease (PD) is one of the most common neurodegenerative diseases. Its pathogenesis is based on diminution of neurons in substantia nigra, that under normal conditions acts as the source of dopamine in nigrostriatal circuit. The decline of dopamine concentration caused by death of dopaminergic neurons is responsible for the appearance of symptoms typical for the mentioned disease. Along with pharmacotherapy, with its most impressive success - that is delivery of the precursor of dopamine (L-DOPA) to the central nervous system--surgical methods are developed for treatment of PD. The basis of these approaches consist of "switching off" the nigrostriatal structures that are overactive due to lack of inhibiting action performed normally by dopamine. Stereotactic neurosurgery - enabling safe access to the region of basal ganglia, thalamus and subthalamic nucleus can be an important solution for many patients with the PD unresponding to pharmacological therapy. Depending on the procedure irreversible lesions or stimulation leading to reversible block can be done in order to restore physiological functional conditions within nigrostriatal circuit. The new, experimental method of curing PD is transplantaton of dopaminergic rich neurons from fetal mesencephalic tissue. Despite very promising results, this procedure is very controversial due to ethical problems concerning aspects of fetal graft acquisition. In the authors' point of view, the only chance for making the concept of neurotransplantation applicable is the use of neural stem cells that are able not only to renew dopaminergic neuron population, but also, thanks to gene therapy--introducing key substances (e.g. thyrosine hydroxylase, glial cell line-derived neurotrophic factor) and elimination the cause of parkinsonian disturbances.
帕金森病（PD）是最常见的神经退行性疾病之一。其发病机制基于黑质中神经元的减少，在正常情况下，黑质是黑质纹状体回路中多巴胺的来源。多巴胺能神经元死亡导致的多巴胺浓度下降是上述疾病典型症状出现的原因。除了药物治疗，其最显著的成功之处在于将多巴胺前体（左旋多巴）输送到中枢神经系统，还开发了手术方法来治疗帕金森病。这些方法的基础是“关闭”由于多巴胺正常抑制作用缺失而过度活跃的黑质纹状体结构。立体定向神经外科手术能够安全进入基底神经节、丘脑和丘脑底核区域，对于许多对药物治疗无反应的帕金森病患者来说可能是一个重要的解决方案。根据手术方式，可以进行不可逆损伤或导致可逆阻断的刺激，以恢复黑质纹状体回路内的生理功能状态。治疗帕金森病的新的实验方法是移植来自胎儿中脑组织的富含多巴胺能的神经元。尽管结果非常有前景，但由于胎儿移植物获取方面的伦理问题，该手术极具争议性。在作者看来，使神经移植概念可行的唯一机会是使用神经干细胞，它不仅能够更新多巴胺能神经元群体，还能通过基因治疗引入关键物质（如酪氨酸羟化酶、胶质细胞源性神经营养因子）并消除帕金森病紊乱的病因。
