Stathis Pantelis, Konitsiotis Spiridon, Antonini Angelo
Department of Neurology, Mediterraneo Hospital, Glyfada, Athens, Greece.
Expert Rev Neurother. 2015 Feb;15(2):207-13. doi: 10.1586/14737175.2015.1001747. Epub 2015 Jan 12.
Dyskinesias are common, often disabling motor complications emerging in Parkinson's disease following chronic levodopa treatment. Common views associate the development of dyskinesias both with progressive loss of striatal dopamine nerve terminals and with intermittent delivery of the short half-life levodopa. Thus, according to continuous dopaminergic stimulation theory, dopamine agonists having half-lifes longer than levodopa would minimize the risk of the development of dyskinesias. The article highlights some interesting aspects of the clinical trials testing dopamine agonists monotherapy as a strategy that can reduce the risk of motor complications, and raises some concerns in terms of their early use in Parkinson's disease treatment to prevent or delay dyskinesia. Finally, we emphasize the need for reconsideration of arguments against use of levodopa as a starting therapy for Parkinson's disease.
运动障碍是帕金森病患者在长期左旋多巴治疗后常见的、往往导致失能的运动并发症。普遍观点认为，运动障碍的发生既与纹状体多巴胺神经末梢的渐进性丧失有关，也与半衰期较短的左旋多巴的间歇性给药有关。因此，根据持续多巴胺能刺激理论，半衰期比左旋多巴长的多巴胺激动剂将使运动障碍发生的风险降至最低。本文重点介绍了以多巴胺激动剂单药治疗作为降低运动并发症风险策略的临床试验的一些有趣方面，并对其在帕金森病治疗中早期使用以预防或延迟运动障碍提出了一些担忧。最后，我们强调需要重新审视反对将左旋多巴作为帕金森病起始治疗药物的观点。
