Du Juan-Juan, Chen Sheng-Di
Department of Neurology and Institute of Neurology, Ruijin Hospital Affiliated to Shanghai Jiao Tong University School of Medicine, Shanghai 200025, China.
Chin Med J (Engl). 2017 Aug 5;130(15):1856-1866. doi: 10.4103/0366-6999.211555.
The aim of this study was to summarize recent studies on nondopaminergic options for the treatment of motor symptoms in Parkinson's disease (PD).
Papers in English published in PubMed, Cochrane, and Ovid Nursing databases between January 1988 and November 2016 were searched using the following keywords: PD, nondopaminergic therapy, adenosine, glutamatergic, adrenergic, serotoninergic, histaminic, and iron chelator. We also reviewed the ongoing clinical trials in the website of clinicaltrials.gov.
Articles related to the nondopaminergic treatment of motor symptoms in PD were selected for this review.
PD is conventionally treated with dopamine replacement strategies, which are effective in the early stages of PD. Long-term use of levodopa could result in motor complications. Recent studies revealed that nondopaminergic systems such as adenosine, glutamatergic, adrenergic, serotoninergic, histaminic, and iron chelator pathways could include potential therapeutic targets for motor symptoms, including motor fluctuations, levodopa-induced dyskinesia, and gait disorders. Some nondopaminergic drugs, such as istradefylline and amantadine, are currently used clinically, while most such drugs are in preclinical testing stages. Transitioning of these agents into clinically beneficial strategies requires reliable evaluation since several agents have failed to show consistent results despite positive findings at the preclinical level.
Targeting nondopaminergic transmission could improve some motor symptoms in PD, especially the discomfort of dyskinesia. Although nondopaminergic treatments show great potential in PD treatment as an adjunct therapy to levodopa, further investigation is required to ensure their success.
本研究旨在总结近期关于帕金森病（PD）运动症状非多巴胺能治疗方案的研究。
使用以下关键词检索了1988年1月至2016年11月期间发表在PubMed、Cochrane和Ovid护理数据库中的英文论文：PD、非多巴胺能治疗、腺苷、谷氨酸能、肾上腺素能、血清素能、组胺能和铁螯合剂。我们还在clinicaltrials.gov网站上查看了正在进行的临床试验。
本综述选取了与PD运动症状非多巴胺能治疗相关的文章。
PD传统上采用多巴胺替代策略进行治疗，该策略在PD早期有效。长期使用左旋多巴可能导致运动并发症。近期研究表明，腺苷、谷氨酸能、肾上腺素能、血清素能、组胺能和铁螯合剂途径等非多巴胺能系统可能是运动症状的潜在治疗靶点，这些运动症状包括运动波动、左旋多巴诱发的运动障碍和步态障碍。一些非多巴胺能药物，如异他司琼和金刚烷胺，目前已在临床使用，而大多数此类药物正处于临床前测试阶段。将这些药物转化为具有临床益处的策略需要可靠的评估，因为尽管一些药物在临床前水平有阳性结果，但仍未能显示出一致的效果。
针对非多巴胺能传递可能改善PD的一些运动症状，尤其是运动障碍的不适。尽管非多巴胺能治疗作为左旋多巴的辅助治疗在PD治疗中显示出巨大潜力，但仍需要进一步研究以确保其成功。
