Thanvi Bhomraj, Lo Nelson, Robinson Tom
Department of Integrated Medicine, Leicester General Hospital, University Hospitals of Leicester NHS Trust, Leicester, UK.
Postgrad Med J. 2007 Jun;83(980):384-8. doi: 10.1136/pgmj.2006.054759.
Levodopa is the most effective drug for treating Parkinson's disease. However, long-term use of levodopa is often complicated by significantly disabling fluctuations and dyskinesias negating its beneficial effects. Younger age of Parkinson's disease onset, disease severity, and high levodopa dose increase the risk of development of levodopa-induced dyskinesias (LID). The underlying mechanisms for LID are unclear though recent studies indicate the importance of pulsatile stimulation of striatal postsynaptic receptors in their pathogenesis. The non-human primates with MPTP-induced parkinsonism serve as a useful model to study dyskinesia. Once established, LID are difficult to treat and therefore efforts should be made to prevent them. The therapeutic and preventative strategies for LID include using a lower dosage of levodopa, employing dopamine agonists as initial therapy in Parkinson's disease, amantadine, atypical neuroleptics, and neurosurgery. LID can adversely affect the quality of life and increase the cost of healthcare.
左旋多巴是治疗帕金森病最有效的药物。然而，长期使用左旋多巴常常会出现严重的致残性波动和异动症，抵消了其有益作用。帕金森病发病年龄较轻、疾病严重程度以及高剂量左旋多巴会增加左旋多巴诱导的异动症（LID）的发生风险。尽管最近的研究表明纹状体突触后受体的脉冲刺激在其发病机制中具有重要性，但LID的潜在机制尚不清楚。用MPTP诱导帕金森病的非人灵长类动物是研究异动症的有用模型。一旦形成，LID很难治疗，因此应努力预防。LID的治疗和预防策略包括使用较低剂量的左旋多巴、在帕金森病初始治疗中使用多巴胺激动剂、金刚烷胺、非典型抗精神病药物以及神经外科手术。LID会对生活质量产生不利影响，并增加医疗保健成本。
