Institute of Neurological Sciences, Glasgow, Scotland, UK.
J Neurol Sci. 2010 Feb 15;289(1-2):115-8. doi: 10.1016/j.jns.2009.08.053. Epub 2009 Sep 29.
The response to dopamine replacement therapy in patients with degenerative parkinsonism is variable. Reasons for a poor therapy response include the type of parkinsonism, comorbidities, and differential effects on clinical features. An additional explanation, which has received much less attention, is sub-optimal therapy compliance. Single and multicentre studies of therapy compliance report significant under- and overuse of dopamine replacement therapy resulting in poor symptomatic control, or features of the dopamine dysregulation syndrome or other signs of dopaminergic excess (dyskinesia, confusion, visual hallucinations). In this article, the evidence for sub-optical adherence in Parkinson's disease (PD) is reviewed, and factors associated with sub-optimal compliance were examined, with two case vignettes to illustrate clinical consequences of deviation from the prescribed therapy regimen.
在退行性帕金森病患者中，对多巴胺替代疗法的反应是可变的。治疗反应不佳的原因包括帕金森病的类型、合并症以及对临床特征的不同影响。另一个解释，虽然受到的关注较少，但治疗依从性差也是一个原因。关于治疗依从性的单中心和多中心研究报告称，多巴胺替代疗法的使用存在显著不足和过度，导致症状控制不佳，或出现多巴胺失调综合征的特征或其他多巴胺能亢进的迹象（运动障碍、意识混乱、视觉幻觉）。本文回顾了帕金森病（PD）中治疗依从性不足的证据，并研究了与治疗依从性差相关的因素，通过两个病例示例说明了偏离规定治疗方案的临床后果。
