Departments of Neurology and Neuroscience, Mount Sinai School of Medicine, New York, NY.
Ann Neurol. 2013 Sep;74(3):337-47. doi: 10.1002/ana.24011.
Dopaminergic therapies such as levodopa have provided benefit for millions of patients with Parkinson's disease (PD) and revolutionized the treatment of this disorder. However patients continue to experience disability despite the best of modern treatment. Dopaminergic and surgical therapies are associated with potentially serious side effects. Non-motor and non-dopaminergic features such as freezing, falling, and dementia are not adequately controlled with available medications and represent the major source of disability for advanced patients. And, the disease continues to relentlessly progress. Major therapeutic unmet needs include a dopaminergic therapy that is not associated with serious side effects, a therapy that addresses the non-motor and non-dopaminergic features of the disease, and a disease-modifying therapy that slows or stops disease progression. This review will consider current attempts to address these issues and the obstacles that must be overcome in order to develop more effective therapies for PD.
多巴胺能疗法,如左旋多巴,已经为数百万帕金森病 (PD) 患者带来了益处,并彻底改变了这种疾病的治疗方法。然而,尽管采用了现代最好的治疗方法,患者仍继续面临残疾。多巴胺能和手术治疗与潜在的严重副作用有关。非运动和非多巴胺能特征,如冻结、跌倒和痴呆,不能通过现有的药物得到充分控制,这是晚期患者残疾的主要原因。此外,疾病仍在无情地进展。主要的治疗未满足需求包括一种不伴有严重副作用的多巴胺能疗法,一种能解决疾病的非运动和非多巴胺能特征的疗法,以及一种能减缓或阻止疾病进展的疾病修饰疗法。这篇综述将考虑目前解决这些问题的尝试,以及为 PD 开发更有效的疗法必须克服的障碍。