Zhang Jinglin, Tan Louis Chew-Seng
Parkinson's Disease and Movement Disorder Center, Department of Neurology, National Neuroscience Institute, Republic of Singapore, USA National Parkinson Foundation International Center of Excellence, Singapore, 11 Jalan Tan Tock Seng, Singapore, 308433.
Curr Neuropharmacol. 2016;14(4):356-63. doi: 10.2174/1570159x14666151208114634.
The optimal treatment strategy for Parkinson's disease has been debated for decades. The introduction of levodopa (LD) treatment is frequently delayed because of theoretical concerns about its toxicity or the risk of drug-induced motor complications. These concerns have resulted in "LD phobia" with clinicians selecting dopamine agonist (DA) over LD as initial therapy. More recently, a shift in the treatment approach towards initial LD use appears to be occurring. It is therefore necessary to review current evidence for the use of LD and DA. This review discusses the medical management of Parkinson's disease with regards to the use of LD versus DA. Pendulum swings in treatment strategies between LD-first and DA-first therapies should be avoided. A balanced perspective is needed as there is a place for both drugs in the management of PD.
几十年来，帕金森病的最佳治疗策略一直存在争议。由于对左旋多巴（LD）毒性或药物诱发运动并发症风险的理论担忧，其治疗的引入常常被推迟。这些担忧导致了“LD恐惧症”，临床医生选择多巴胺激动剂（DA）而非LD作为初始治疗。最近，治疗方法似乎正转向初始使用LD。因此，有必要回顾当前使用LD和DA的证据。本综述讨论了帕金森病在使用LD与DA方面的药物治疗。应避免在LD优先和DA优先治疗策略之间摇摆不定。需要一个平衡的观点，因为这两种药物在帕金森病的治疗中都有一席之地。
