Chaná Pedro
Neurología, Centro de trastornos del Movimiento, Facultad de Ciencias Médicas, Universidad de Santiago de Chile, Chile.
Parkinsonism Relat Disord. 2009 Dec;15 Suppl 3:S22-5. doi: 10.1016/S1353-8020(09)70773-4.
Parkinson's disease (PD) is a common progressive neurodegenerative disorder. Dopamine replacement therapy considerably reduces motor handicap. Although levodopa continues as the gold standard for efficacy, its chronic use is associated with potentially disabling motor complications. Strategies to treat levodopa-related motor complications are only partially effective. Best results are currently achieved with invasive strategies via subcutaneous (s.c.) or intraduodenal delivery of apomorphine or levodopa, or deep brain stimulation of the subthalamic nucleus. This presentation will develop the current treatment principles for PD: (1) L-dopa does not accelerate disease progression, (2) no treatment modality exerts neuroprotective effects, (3) L-dopa is more effective than dopamine agonists in alleviating motor symptoms and improving the activities of daily living (ADL) score, in parkinsonian patients, (4) Treatment with dopamine agonist is associated with fewer motor complications than L-dopa. (5) Dopamine agonist therapy is associated with more frequent adverse events than L-dopa therapy, such as hallucinations and somnolence. There is no evidence of a long-term benefit with initial dopamine agonist therapy.
帕金森病（PD）是一种常见的进行性神经退行性疾病。多巴胺替代疗法可显著减轻运动障碍。尽管左旋多巴仍是疗效的金标准，但其长期使用会引发潜在的致残性运动并发症。治疗左旋多巴相关运动并发症的策略仅部分有效。目前通过皮下（s.c.）或十二指肠内注射阿扑吗啡或左旋多巴的侵入性策略，或丘脑底核深部脑刺激可取得最佳效果。本报告将阐述当前帕金森病的治疗原则：（1）左旋多巴不会加速疾病进展；（2）没有任何治疗方式具有神经保护作用；（3）在帕金森病患者中，左旋多巴在缓解运动症状和提高日常生活活动（ADL）评分方面比多巴胺激动剂更有效；（4）多巴胺激动剂治疗比左旋多巴引发的运动并发症更少；（5）多巴胺激动剂治疗比左旋多巴治疗引发的不良事件更频繁，如幻觉和嗜睡。没有证据表明初始多巴胺激动剂治疗具有长期益处。
