Thobois S, Broussolle E, Remy P
Service de Neurologie D, CERMEP et INSERM U534, Hôpital Neurologique et Neurochirurgical Pierre-Wertheimer, Lyon.
Rev Neurol (Paris). 2005 Apr;161(4):385-93. doi: 10.1016/s0035-3787(05)85068-4.
The development of neuroprotective strategies is a crucial issue for Parkinson's disease, since up to now only symptomatic therapies are available. The clinical evaluation of neuroprotective drugs is difficult considering the long-term effect of anti-Parkinsonian medication that nearly make impossible accurate measurement of the "true" clinical stage of the disease in the early years of progression.
Two recent functional imaging studies (CALM-PD and REAL-PET) using positron emission tomography (PET) or single photon emission computed tomography (SPECT), suggest that dopamine agonist may have a neuroprotective effect compared to L-Dopa.
These results are still controversial, notably because of the lack of clinical-imaging correlations, the absence of a placebo group and some important methodological considerations. Nevertheless, these studies are encouraging and give some arguments for the potential neuroprotective role of dopamine agonists. The aim of this work is first to present the pros and cons of these studies and second to propose guidelines in order to improve the design and methodology for future studies designed to assess the neuroprotective properties of new drugs in Parkinson's disease.
神经保护策略的发展是帕金森病的一个关键问题，因为到目前为止只有对症治疗方法。考虑到抗帕金森药物的长期作用，神经保护药物的临床评估很困难，这几乎使得在疾病进展的早期准确测量疾病的“真正”临床阶段变得不可能。
最近两项使用正电子发射断层扫描（PET）或单光子发射计算机断层扫描（SPECT）的功能成像研究（CALM-PD和REAL-PET）表明，与左旋多巴相比，多巴胺激动剂可能具有神经保护作用。
这些结果仍存在争议，特别是因为缺乏临床与成像的相关性、没有安慰剂组以及一些重要的方法学考虑因素。然而，这些研究令人鼓舞，并为多巴胺激动剂的潜在神经保护作用提供了一些依据。这项工作的目的首先是阐述这些研究的利弊，其次是提出指导方针，以改进未来旨在评估帕金森病新药神经保护特性的研究的设计和方法。
