Movement Disorders Unit, Department of Neurology, Westmead Hospital, Darcy Rd, Westmead, NSW, 2145, Australia.
CNS Drugs. 2013 Feb;27(2):97-112. doi: 10.1007/s40263-012-0012-3.
Postural instability is one of the cardinal signs in Parkinson's disease (PD). It can be present even at diagnosis, but becomes more prevalent and worsens with disease progression. It represents one of the most disabling symptoms in the advanced stages of the disease, as it is associated with increased falls and loss of independence. Clinical and posturographic studies have contributed to significant advances in unravelling the complex pathophysiology of postural instability in patients with PD, but it still remains yet to be fully clarified, partly due to the difficulty in distinguishing between the disease process and the compensatory mechanisms, but also due to the fact that non-standardized techniques are used to measure balance and postural instability. There is increasing evidence that physical therapy, especially highly challenging balance exercises, can improve postural stability and reduce the risk of falls, although the long-term effects of physical therapy interventions on postural stability need to be explored given the progressive nature of PD. Pharmacotherapy with dopaminergic medications can provide significant improvements in postural instability in early- to mid-stage PD but the effects tend to wane with time consistent with spread of the disease process to non-dopaminergic pathways in advanced PD. Donepezil has been associated with a reduced risk of falls and methylphenidate has shown potential benefit against freezing of gait, but the results are yet to be replicated in large randomized studies. Surgical treatments, including lesioning and deep brain stimulation surgery targeting the subthalamic nucleus and the globus pallidus internus, tend to only provide modest benefit for postural instability. New surgical targets such as the pedunculopontine nucleus have emerged as a potential specific therapy for postural instability and gait disorder but remain experimental.
姿势不稳是帕金森病（PD）的主要特征之一。即使在诊断时也可能存在，但随着疾病的进展，它会变得更加普遍和恶化。它是疾病晚期最致残的症状之一，因为它与跌倒增加和丧失独立性有关。临床和姿势描记术研究有助于深入了解 PD 患者姿势不稳的复杂病理生理学，但仍有待充分阐明，部分原因是难以区分疾病过程和代偿机制，部分原因是用于测量平衡和姿势不稳的技术不标准化。越来越多的证据表明，物理疗法，尤其是极具挑战性的平衡练习，可以改善姿势稳定性并降低跌倒风险，尽管鉴于 PD 的进行性性质，需要探讨物理治疗干预对姿势稳定性的长期影响。多巴胺能药物的药物治疗可以在 PD 的早中期显著改善姿势不稳，但随着疾病过程向晚期 PD 的非多巴胺能途径扩散，其效果往往会随着时间的推移而减弱。多奈哌齐与跌倒风险降低有关，哌甲酯显示出对冻结步态的潜在益处，但这些结果尚未在大型随机研究中得到复制。手术治疗，包括针对丘脑底核和苍白球 internus 的损毁术和深部脑刺激术，往往只能为姿势不稳提供适度的益处。新的手术靶点，如动眼神经核，已成为姿势不稳和步态障碍的潜在特定治疗方法，但仍处于实验阶段。
