Department of Neurology, University Clinic of Würzburg, Josef-Schneider-Str. 11, 97080, Würzburg, Germany,
J Neurol. 2013 Nov;260(11):2701-14. doi: 10.1007/s00415-012-6798-6. Epub 2013 Jan 5.
Motor complications in Parkinson's disease (PD) result from the short half-life and irregular plasma fluctuations of oral levodopa. When strategies of providing more continuous dopaminergic stimulation by adjusting oral medication fail, patients may be candidates for one of three device-aided therapies: deep brain stimulation (DBS), continuous subcutaneous apomorphine infusion, or continuous duodenal/jejunal levodopa/carbidopa pump infusion (DLI). These therapies differ in their invasiveness, side-effect profile, and the need for nursing care. So far, very few comparative studies have evaluated the efficacy of the three device-aided therapies for specific motor problems in advanced PD. As a result, neurologists currently lack guidance as to which therapy could be most appropriate for a particular PD patient. A group of experts knowledgeable in all three therapies reviewed the currently available literature for each treatment and identified variables of clinical relevance for choosing one of the three options such as type of motor problems, age, and cognitive and psychiatric status. For each scenario, pragmatic and (if available) evidence-based recommendations are provided as to which patients could be candidates for either DBS, DLI, or subcutaneous apomorphine.
帕金森病（PD）的运动并发症是由于口服左旋多巴半衰期短和血浆波动不规则引起的。当通过调整口服药物提供更持续的多巴胺能刺激的策略失败时，患者可能是三种设备辅助治疗之一的候选者：深部脑刺激（DBS）、持续皮下阿朴吗啡输注或持续十二指肠/空肠左旋多巴/卡比多巴泵输注（DLI）。这些治疗方法在侵袭性、副作用谱和护理需求方面存在差异。到目前为止，很少有比较研究评估了这三种设备辅助疗法对晚期 PD 特定运动问题的疗效。因此，神经科医生目前缺乏指导，无法确定哪种疗法对特定的 PD 患者最适用。一组精通所有三种疗法的专家审查了每种治疗方法的现有文献，并确定了选择三种选择之一的临床相关变量，例如运动问题的类型、年龄以及认知和精神状态。对于每种情况，都提供了实用的（如果有的话）基于证据的建议，说明哪些患者可能适合 DBS、DLI 或皮下阿朴吗啡。
