Department for Parkinson's Disease, Clinic San Pio X, Milan, Italy.
Parkinsonism Relat Disord. 2012 Jan;18 Suppl 1:S120-2. doi: 10.1016/S1353-8020(11)70037-2.
Levodopa is the most effective treatment for Parkinson's disease (PD) for both motor and non-motor control. Pulsatile levodopa administration likely contributes to the development of motor fluctuations and dyskinesia after a few years. All studies comparing levodopa versus dopamine agonist early therapy indicate that initiation with agonists is associated with a reduced risk of motor complications - in particular, dyskinesias - possibly because agonists' longer half-lives provide continuous dopaminergic delivery. Indeed, this therapeutic strategy may delay the emergence of motor fluctuations and dyskinesia which is essential to maintaining satisfactory quality of life. In advanced disease various levodopa-based strategies may be tried to control motor complications, such as dose fragmentation (smaller, more frequent dosing) or the use of orally administered, liquid levodopa formulations that may reduce off-time intervals or facilitate absorption. More recently introduced, continuous levodopa delivery by duodenal infusion (but also apomorphine infusion) may represent a more effective approach to treat motor complications in advanced PD, and its effect can be perceived by improvement both in clinical scales as well as in health-related items. Infusion therapies may reverse motor complications in complicated patients with significant benefit on quality of life.
左旋多巴是治疗帕金森病（PD）运动和非运动控制的最有效药物。脉冲式左旋多巴给药可能导致运动波动和几年后出现运动障碍。所有比较左旋多巴与多巴胺激动剂早期治疗的研究都表明，使用激动剂起始治疗与降低运动并发症的风险相关 - 特别是运动障碍 - 可能是因为激动剂的半衰期较长，可提供持续的多巴胺能传递。事实上，这种治疗策略可能会延迟运动波动和运动障碍的出现，这对于维持令人满意的生活质量至关重要。在晚期疾病中，可以尝试各种基于左旋多巴的策略来控制运动并发症，例如剂量分割（更小、更频繁的剂量）或使用口服、液体左旋多巴制剂，这可能会减少无运动时间间隔或促进吸收。最近引入的十二指肠输注（也包括阿朴吗啡输注）连续左旋多巴给药可能代表了一种更有效的治疗晚期 PD 运动并发症的方法，其效果可以通过改善临床量表以及与健康相关的项目来感知。输注疗法可能会逆转复杂患者的运动并发症，对生活质量有显著的益处。
