Institute of Neurology CCS, School of Medicine, Belgrade, Serbia.
Parkinsonism Relat Disord. 2009 Dec;15 Suppl 4:S71-5. doi: 10.1016/S1353-8020(09)70839-9.
For mostly arbitrary reasons, the term "juvenile parkinsonism" is restricted to patients aged 20 years or younger, and "young-onset PD" (YOPD) is onset between ages 21 and 40 years. Previous studies suggest that YOPD has a slower disease progression and a greater incidence and earlier appearance of L-dopa-induced dyskinesias and motor fluctuations. Therefore, our therapeutic strategies have to respect the fact that YOPD patients face many years of gradual progression of disease and disability, a greater probability for developing various adverse effects of treatment, and worsening of quality of life. As an individually tailored treatment should be our primary goal, we must bear in mind that the needs and expectations of YOPD patients are different from those of their older counterparts. The therapeutic strategy for YOPD patients should include a relatively low threshold for initiation of treatment, and initiating treatment with a dopamine receptor agonist while maintaining an individually adjusted, moderately high threshold for switching to or adding L-dopa in cases where treatment response is suboptimal or if problematic adverse effects develop. It has been shown that some dopamine receptor agonists may also have antidepressive efficacy, thus potentially managing an additional problem associated with PD.
出于一些任意的原因，术语“青少年帕金森病”仅限于 20 岁或以下的患者，而“早发性帕金森病”（YOPD）的发病年龄在 21 至 40 岁之间。之前的研究表明，YOPD 的疾病进展较慢，并且 L-多巴诱导的运动障碍和运动波动的发生率更高，出现更早。因此，我们的治疗策略必须尊重这样一个事实，即 YOPD 患者面临着多年的疾病逐渐进展和残疾，出现各种治疗不良反应的可能性更大，以及生活质量恶化。由于个体化的治疗应该是我们的首要目标，我们必须牢记，YOPD 患者的需求和期望与他们的老年患者不同。YOPD 患者的治疗策略应包括相对较低的治疗启动阈值，并在治疗反应不佳或出现有问题的不良反应时，使用多巴胺受体激动剂开始治疗，同时保持个人调整的、适度高的阈值，以转换或添加 L-多巴。已经表明，一些多巴胺受体激动剂也可能具有抗抑郁作用，从而潜在地解决与 PD 相关的另一个问题。
