Department of Psychiatry and Neuroscience Program, Harvard Medical School, McLean Hospital, Belmont, MA 02478, USA.
Department of Psychiatry and Neuroscience Program, Harvard Medical School, McLean Hospital, Belmont, MA 02478, USA; School of Medicine, American University of Beirut, Beirut, Lebanon.
Pharmacol Ther. 2014 Nov;144(2):123-33. doi: 10.1016/j.pharmthera.2014.05.010. Epub 2014 May 20.
The prevalence of Parkinson's disease (PD) increases with age and is projected to increase in parallel to the rising average age of the population. The disease can have significant health-related, social, and financial implications not only for the patient and the caregiver, but for the health care system as well. While the neuropathology of this neurodegenerative disorder is fairly well understood, its etiology remains a mystery, making it difficult to target therapy. The currently available drugs for treatment provide only symptomatic relief and do not control or prevent disease progression, and as a result patient compliance and satisfaction are low. Several emerging pharmacotherapies for PD are in different stages of clinical development. These therapies include adenosine A2A receptor antagonists, glutamate receptor antagonists, monoamine oxidase inhibitors, anti-apoptotic agents, and antioxidants such as coenzyme Q10, N-acetyl cysteine, and edaravone. Other emerging non-pharmacotherapies include viral vector gene therapy, microRNAs, transglutaminases, RTP801, stem cells and glial derived neurotrophic factor (GDNF). In addition, surgical procedures including deep brain stimulation, pallidotomy, thalamotomy and gamma knife surgery have emerged as alternative interventions for advanced PD patients who have completely utilized standard treatments and still suffer from persistent motor fluctuations. While several of these therapies hold much promise in delaying the onset of the disease and slowing its progression, more pharmacotherapies and surgical interventions need to be investigated in different stages of PD. It is hoped that these emerging therapies and surgical procedures will strengthen our clinical armamentarium for improved treatment of PD.
帕金森病（PD）的患病率随着年龄的增长而增加，预计将与人口平均年龄的上升呈平行趋势。这种疾病不仅对患者和护理人员，而且对医疗保健系统也会产生重大的健康相关、社会和经济影响。虽然这种神经退行性疾病的神经病理学已经相当清楚，但它的病因仍然是个谜，这使得靶向治疗变得困难。目前用于治疗的药物只能提供症状缓解，不能控制或预防疾病进展，因此患者的依从性和满意度都很低。几种用于治疗 PD 的新兴药物治疗方法处于不同的临床开发阶段。这些疗法包括腺苷 A2A 受体拮抗剂、谷氨酸受体拮抗剂、单胺氧化酶抑制剂、抗细胞凋亡剂和抗氧化剂，如辅酶 Q10、N-乙酰半胱氨酸和依达拉奉。其他新兴的非药物治疗方法包括病毒载体基因治疗、microRNAs、转谷氨酰胺酶、RTP801、干细胞和胶质衍生神经营养因子（GDNF）。此外，深部脑刺激、苍白球切开术、丘脑切开术和伽玛刀手术等外科手术已成为完全采用标准治疗方法但仍存在持续性运动波动的晚期 PD 患者的替代干预措施。虽然这些疗法中的许多在延迟疾病的发作和减缓其进展方面都有很大的希望，但仍需要在 PD 的不同阶段对更多的药物治疗和手术干预进行研究。希望这些新兴的治疗方法和手术程序将增强我们的临床治疗手段，以改善 PD 的治疗效果。
