Magrinelli Francesca, Picelli Alessandro, Tocco Pierluigi, Federico Angela, Roncari Laura, Smania Nicola, Zanette Giampietro, Tamburin Stefano
Department of Neurosciences, Biomedicine and Movement Sciences, University of Verona, Piazzale Scuro 10, 37134 Verona, Italy.
Department of Neurosciences, Biomedicine and Movement Sciences, University of Verona, Piazzale Scuro 10, 37134 Verona, Italy; Neuromotor and Cognitive Rehabilitation Research Centre, University of Verona, Piazzale Scuro 10, 37134 Verona, Italy.
Parkinsons Dis. 2016;2016:9832839. doi: 10.1155/2016/9832839. Epub 2016 Jun 6.
Cardinal motor features of Parkinson's disease (PD) include bradykinesia, rest tremor, and rigidity, which appear in the early stages of the disease and largely depend on dopaminergic nigrostriatal denervation. Intermediate and advanced PD stages are characterized by motor fluctuations and dyskinesia, which depend on complex mechanisms secondary to severe nigrostriatal loss and to the problems related to oral levodopa absorption, and motor and nonmotor symptoms and signs that are secondary to marked dopaminergic loss and multisystem neurodegeneration with damage to nondopaminergic pathways. Nondopaminergic dysfunction results in motor problems, including posture, balance and gait disturbances, and fatigue, and nonmotor problems, encompassing depression, apathy, cognitive impairment, sleep disturbances, pain, and autonomic dysfunction. There are a number of symptomatic drugs for PD motor signs, but the pharmacological resources for nonmotor signs and symptoms are limited, and rehabilitation may contribute to their treatment. The present review will focus on classical notions and recent insights into the neuropathology, neuropharmacology, and neurophysiology of motor dysfunction of PD. These pieces of information represent the basis for the pharmacological, neurosurgical, and rehabilitative approaches to PD.
帕金森病（PD）的主要运动特征包括运动迟缓、静止性震颤和肌强直，这些症状出现在疾病早期，主要取决于多巴胺能黑质纹状体去神经支配。帕金森病的中期和晚期以运动波动和异动症为特征，这取决于严重黑质纹状体缺失继发的复杂机制以及与口服左旋多巴吸收相关的问题，还包括明显多巴胺能缺失和多系统神经变性伴非多巴胺能通路损伤继发的运动和非运动症状及体征。非多巴胺能功能障碍导致运动问题，包括姿势、平衡和步态障碍以及疲劳，还导致非运动问题，包括抑郁、冷漠、认知障碍、睡眠障碍、疼痛和自主神经功能障碍。有多种用于治疗帕金森病运动体征的对症药物，但用于治疗非运动体征和症状的药物资源有限，康复治疗可能有助于其治疗。本综述将聚焦于帕金森病运动功能障碍的神经病理学、神经药理学和神经生理学的经典概念及最新见解。这些信息是帕金森病药物治疗、神经外科治疗和康复治疗方法的基础。
