Department of Neurology, University Hospital of Ioannina, Greece.
Prog Neuropsychopharmacol Biol Psychiatry. 2011 Dec 1;35(8):1795-807. doi: 10.1016/j.pnpbp.2011.05.014. Epub 2011 May 30.
Patients with advanced Parkinson's disease (PD) are known to develop motor complications after a few years of levodopa (L-dopa) therapy. Motor fluctuations develop with increasing severity of the disease, owing to loss of dopaminergic neurons and loss of the buffering capacity of the neurons to fluctuating dopamine levels. Dyskinesias develop as a result of pulsatile stimulation of the receptors and alterations in neuronal firing patterns. L-dopa remains the gold standard medication for the treatment of patients with advanced PD. However, once motor complications on L-dopa therapy emerge, clinicians may add on other classes of antiparkinsonian drugs such as dopamine agonists, catechol-O-methyl transferase inhibitors (COMTIs) or monoamine oxidase type B inhibitors (MAOBIs). The individualisation of the treatment seems to be the key for the best approach of advanced PD patients. The present review provides the most important current clinical data in the pharmacological treatment of motor symptoms in advanced PD and provides the clinician a simple algorithm in order to determine the best suitable treatment to advanced parkinsonian patients.
患有晚期帕金森病 (PD) 的患者在接受左旋多巴 (L-dopa) 治疗几年后会出现运动并发症。随着疾病的严重程度不断加重，由于多巴胺能神经元的丧失和神经元对波动的多巴胺水平的缓冲能力的丧失，运动波动会不断发展。运动障碍是由于受体的脉冲刺激和神经元放电模式的改变而产生的。左旋多巴仍然是治疗晚期 PD 患者的金标准药物。然而，一旦出现左旋多巴治疗的运动并发症，临床医生可能会添加其他类别的抗帕金森病药物，如多巴胺激动剂、儿茶酚-O-甲基转移酶抑制剂 (COMTIs) 或单胺氧化酶 B 抑制剂 (MAOBIs)。治疗的个体化似乎是晚期 PD 患者最佳治疗方法的关键。本综述提供了晚期 PD 中运动症状药物治疗的最新重要临床数据，并为临床医生提供了一个简单的算法，以确定最适合晚期帕金森病患者的治疗方法。
