Classen Joseph, Koschel Jiri, Oehlwein Christian, Seppi Klaus, Urban Peter, Winkler Christian, Wüllner Ullrich, Storch Alexander
Department of Neurology, University of Leipzig, 04103, Leipzig, Germany.
Parkinson-Klinik Ortenau, 77709, Wolfach, Germany.
J Neural Transm (Vienna). 2017 Aug;124(8):1029-1036. doi: 10.1007/s00702-017-1757-0. Epub 2017 Jul 12.
Parkinson's disease (PD) is a neurodegenerative multisystem disorder characterized by progressive motor symptoms such as bradykinesia, tremor and muscle rigidity. Over the course of the disease, numerous non-motor symptoms, sometimes preceding the onset of motor symptoms, significantly impair patients' quality of life. The significance of non-motor symptoms may outweigh the burden through progressive motor incapacity, especially in later stages of the disease. The advanced stage of the disease is characterized by motor complications such as fluctuations and dyskinesias induced by the long-term application of levodopa therapy. In recent years, it became evident that various non-motor symptoms such as psychiatric symptoms, fatigue and pain also show fluctuations after chronic levodopa therapy (named non-motor fluctuations or NMFs). Although NMFs have moved into the focus of interest, current national guidelines on the treatment of PD may refer to non-motor symptoms and their management, but do not mention NMF, and do not contain recommendations on their management. The present article summarizes major issues related to NMF including clinical phenomenology and pathophysiology, and outlines a number of open issues and topics for future research.
帕金森病（PD）是一种神经退行性多系统疾病，其特征为进行性运动症状，如运动迟缓、震颤和肌肉僵硬。在疾病过程中，许多非运动症状，有时在运动症状出现之前出现，会显著损害患者的生活质量。非运动症状的重要性可能超过因进行性运动功能丧失所带来的负担，尤其是在疾病后期。疾病晚期的特征是运动并发症，如长期应用左旋多巴治疗引起的症状波动和异动症。近年来，很明显各种非运动症状，如精神症状、疲劳和疼痛，在慢性左旋多巴治疗后也会出现波动（称为非运动波动或NMFs）。尽管NMFs已成为关注焦点，但目前关于PD治疗的国家指南可能提及非运动症状及其管理，但未提及NMF，也未包含关于其管理的建议。本文总结了与NMF相关的主要问题，包括临床现象学和病理生理学，并概述了一些未解决的问题以及未来研究的主题。
