Movement Disorder Clinic, Toronto Western Hospital, Toronto, Ontario, Canada.
Mov Disord. 2011 Oct;26 Suppl 3:S2-41. doi: 10.1002/mds.23829.
The objective was to update previous evidence-based medicine reviews of treatments for motor symptoms of Parkinson's disease published between 2002 and 2005. Level I (randomized, controlled trial) reports of pharmacological, surgical, and nonpharmacological interventions for the motor symptoms of Parkinson's disease between January 2004 (2001 for nonpharmacological) and December 2010 were reviewed. Criteria for inclusion, clinical indications, ranking, efficacy conclusions, safety, and implications for clinical practice followed the original program outline and adhered to evidence-based medicine methodology. Sixty-eight new studies qualified for review. Piribedil, pramipexole, pramipexole extended release, ropinirole, rotigotine, cabergoline, and pergolide were all efficacious as symptomatic monotherapy; ropinirole prolonged release was likely efficacious. All were efficacious as a symptomatic adjunct except pramipexole extended release, for which there is insufficient evidence. For prevention/delay of motor fluctuations, pramipexole and cabergoline were efficacious, and for prevention/delay of dyskinesia, pramipexole, ropinirole, ropinirole prolonged release, and cabergoline were all efficacious, whereas pergolide was likely efficacious. Duodenal infusion of levodopa was likely efficacious in the treatment of motor complications, but the practice implication is investigational. Entacapone was nonefficacious as a symptomatic adjunct to levodopa in nonfluctuating patients and nonefficacious in the prevention/delay of motor complications. Rasagiline conclusions were revised to efficacious as a symptomatic adjunct, and as treatment for motor fluctuations. Clozapine was efficacious in dyskinesia, but because of safety issues, the practice implication is possibly useful. Bilateral subthalamic nucleus deep brain stimulation, bilateral globus pallidus stimulation, and unilateral pallidotomy were updated to efficacious for motor complications. Physical therapy was revised to likely efficacious as symptomatic adjunct therapy. This evidence-based medicine review updates the field and highlights gaps for research.
本研究旨在更新 2002 年至 2005 年期间发表的有关帕金森病运动症状治疗的循证医学综述。我们回顾了 2004 年 1 月（非药物治疗为 2001 年）至 2010 年 12 月期间针对帕金森病运动症状的药理学、手术和非药理学干预的一级（随机对照试验）报告。纳入标准、临床适应证、排序、疗效结论、安全性以及对临床实践的影响均遵循原始方案大纲，并符合循证医学方法。有 68 项新研究符合审查标准。吡贝地尔、普拉克索、普拉克索控释剂、罗匹尼罗、罗替高汀、卡麦角林和培高利特作为症状性单药治疗均有效；罗匹尼罗缓释剂可能有效。除普拉克索控释剂外，所有药物作为症状性辅助治疗均有效，但针对后者的证据不足。对于运动波动的预防/延迟，普拉克索和卡麦角林有效，对于运动障碍的预防/延迟，普拉克索、罗匹尼罗、罗匹尼罗缓释剂和卡麦角林均有效，而培高利特可能有效。十二指肠给予左旋多巴可能对运动并发症的治疗有效，但其实践意义仍需进一步研究。恩他卡朋作为非波动患者左旋多巴的辅助治疗无效，也不能预防/延迟运动并发症。雷沙吉兰的结论修订为对运动障碍和运动波动的症状性辅助治疗有效。氯氮平对运动障碍有效，但由于安全性问题，其临床应用意义可能是有用的。双侧丘脑底核深部脑刺激、双侧苍白球刺激和单侧苍白球切开术的更新结果为对运动并发症有效。物理疗法修订为作为症状性辅助治疗可能有效。本循证医学综述更新了该领域的知识，并突出了研究空白。
