Jenner Peter
Neurodegenerative Diseases Research Group, Institute of Pharmaceutical Sciences, Faculty of Health Sciences and Medicine, King's College, London, SE1 1UL UK.
Transl Neurodegener. 2015 Feb 12;4:3. doi: 10.1186/2047-9158-4-3. eCollection 2015.
The problems associated with the pharmacological treatment of the later stages of Parkinson's disease (PD) remain those seen over many years. These centre on a loss of drug effect ('wearing off') with disease progression, the occurrence of dyskinesia, notably with L-dopa use and the appearance of non-motor symptoms that are largely refractory to dopaminergic medication. Treatment strategies in late PD have been dominated by the use of drug combinations and the subtle manipulation of drug dosage. However, change is occurring as the understanding of the basis of motor complications and fluctuations and non-motor symptoms improves. New pharmacological options are expanding with the advent of longer acting versions of existing dopaminergic drugs, new drug delivery systems and the introduction of non-dopaminergic agents able to manipulate motor function both within the basal ganglia and in other brain regions. Non-dopaminergic agents are also being investigated for the treatment of dyskinesia and for the relief of non-motor symptoms. However, while therapy continues to improve, the treatment of late stage PD remains problematic with non-motor symptoms dominating the unmet need in this patient group.
帕金森病（PD）晚期药物治疗相关的问题多年来一直存在。这些问题主要集中在随着疾病进展药物疗效丧失（“剂末现象”）、异动症的出现，尤其是左旋多巴使用相关的异动症，以及多巴胺能药物基本无效的非运动症状的出现。晚期帕金森病的治疗策略主要是联合用药以及对药物剂量的精细调整。然而，随着对运动并发症、症状波动及非运动症状发病机制理解的加深，情况正在发生变化。随着现有多巴胺能药物长效剂型的出现、新的药物递送系统以及能够在基底神经节和其他脑区调节运动功能的非多巴胺能药物的引入，新的药物选择不断增加。非多巴胺能药物也正在被研究用于治疗异动症和缓解非运动症状。然而，尽管治疗在不断改善，但晚期帕金森病的治疗仍然存在问题，非运动症状在这一患者群体未满足的需求中占主导地位。
