Bohnen Nicolaas I, Albin Roger L, Müller Martijn L T M, Chou Kelvin
Department of Radiology, University of Michigan, Ann Arbor, Michigan, USA ; Department of Neurology, University of Michigan, Ann Arbor, Michigan, USA ; Veterans Administration, Ann Arbor, Michigan, USA.
Department of Neurology, University of Michigan, Ann Arbor, Michigan, USA ; Veterans Administration, Ann Arbor, Michigan, USA.
US Neurol. 2011 Nov 1;7(2):100-108. doi: 10.17925/usn.2011.07.02.100.
There is a need to explore non-dopaminergic approaches to treating balance and gait problems in PD. There is emerging evidence on the role of cholinergic denervation of the PPN-thalamus system and falls in PD. Preliminary clinical trial data suggest that the subgroup of PD patients with frequent falls may be suitable candidates for future cholinergic augmentation clinical trials. Recent controlled clinical trials using methylphenidate have been unable to confirm earlier reports of improved gait in PD. Although progressive deterioration of axial motor symptoms occur with DBS of the STN or GPi, new preliminary research suggests that other surgical stimulation sites, such as the PPN, may have a potential benefit on gait and balance impairments in PD. Ongoing vigorous exercise and physical fitness should be highly encouraged to patients with PD who are at risk of physical deconditioning and fear of falling but effective anti-fall physical therapy interventions remain an unmet clinical need.
有必要探索治疗帕金森病平衡和步态问题的非多巴胺能方法。关于中脑脚桥核 - 丘脑系统胆碱能去神经支配与帕金森病跌倒之间的作用，有新的证据出现。初步临床试验数据表明，频繁跌倒的帕金森病患者亚组可能是未来胆碱能增强临床试验的合适人选。最近使用哌醋甲酯的对照临床试验未能证实早期关于帕金森病步态改善的报道。尽管对丘脑底核或苍白球内侧部进行深部脑刺激会导致轴性运动症状逐渐恶化，但新的初步研究表明，其他手术刺激部位，如中脑脚桥核，可能对帕金森病的步态和平衡障碍有潜在益处。对于有身体机能下降风险且害怕跌倒的帕金森病患者，应大力鼓励其持续进行积极的运动和保持身体健康，但有效的防跌倒物理治疗干预措施仍是未满足的临床需求。
