Giugni Juan C, Okun Michael S
Departments of Neurology and Neurosurgery, University of Florida Center for Movement Disorders and Neurorestoration, Gainesville, Florida, USA.
Curr Opin Neurol. 2014 Aug;27(4):450-60. doi: 10.1097/WCO.0000000000000118.
Later stage Parkinson's disease, sometimes referred to as advanced disease, has been characterized by motor complication, as well as by the potential emergence of nonlevodopa responsive motor and nonmotor symptoms. The management of advanced stage Parkinson's disease can be complex. This review summarizes the currently available treatment strategies for addressing advanced Parkinson's disease.
We will discuss the latest pharmacological strategies (e.g., inhibitors of dopamine-metabolizing enzymes, dopamine agonists, and extended release dopamine formulations) for addressing motor dysfunction. We will summarize the risks and benefits of current invasive treatments. Finally, we will address the current evidence supporting the treatment of nonmotor symptoms in the advanced Parkinson's disease patient. We will conclude by detailing the potential nonpharmacological and multidisciplinary approaches for advanced stage Parkinson's disease.
The optimization of levodopa is, in most cases, the most powerful therapeutic option available; however, medication optimization requires an advanced understanding of Parkinson's disease. Failure of conventional pharmacotherapy should precipitate a discussion of the potential risks and benefits of more invasive treatments. Currently, there are no comparative studies of invasive treatment. Among the invasive treatments, deep brain stimulation has the largest amount of existing evidence, but also has the highest individual per patient risk. Nonmotor symptoms will affect quality of life more than the motor Parkinson's disease symptoms, and these nonmotor symptoms should be aggressively treated. Many advanced Parkinson's disease patients will likely benefit from multi and interdisciplinary Parkinson's disease teams with multiple professionals collaborating to develop a collective and tailored strategy for an individual patient.
帕金森病晚期，有时也称为晚期疾病，其特征为运动并发症以及可能出现的对左旋多巴无反应的运动和非运动症状。晚期帕金森病的管理可能很复杂。本综述总结了目前用于治疗晚期帕金森病的可用治疗策略。
我们将讨论用于解决运动功能障碍的最新药理学策略（例如多巴胺代谢酶抑制剂、多巴胺激动剂和缓释多巴胺制剂）。我们将总结当前侵入性治疗的风险和益处。最后，我们将阐述支持治疗晚期帕金森病患者非运动症状的现有证据。我们将通过详细介绍晚期帕金森病潜在的非药物和多学科方法来得出结论。
在大多数情况下，左旋多巴的优化是最有效的治疗选择；然而，药物优化需要对帕金森病有深入的了解。传统药物治疗失败时应讨论更具侵入性治疗的潜在风险和益处。目前，尚无侵入性治疗的比较研究。在侵入性治疗中，深部脑刺激现有证据最多，但每位患者的个体风险也最高。非运动症状对生活质量的影响超过帕金森病运动症状，应积极治疗这些非运动症状。许多晚期帕金森病患者可能会受益于多学科帕金森病团队，由多名专业人员合作制定针对个体患者的集体且量身定制的策略。
