Mundt-Petersen Ulrika, Odin Per
Lund University, Faculty of Medicine, Lund, Sweden.
Lund University, Faculty of Medicine, Lund, Sweden.
Int Rev Neurobiol. 2017;134:1019-1044. doi: 10.1016/bs.irn.2017.05.036. Epub 2017 Jul 24.
Pump-based Parkinson (PD) therapies, including subcutaneous apomorphine infusion (CSA) and levodopa-carbidopa intestinal gel (LCIG), presently constitute the most effective pharmacological treatments available for advanced PD. These therapies are based on a more constant delivery of the dopaminergic drug resulting in a more continuous dopaminergic stimulation and a more stable treatment effect. This can be detected as reduction of time in off, reduction of dyskinesia frequency and severity, as well as increase of time in on without troublesome dyskinesias. A number of open-label studies now suggest that also the nonmotor PD symptomatology can improve under CSA and LCIG therapy. The most consistent improvements are seen concerning sleep, mood, and apathy, gastrointestinal symptoms, and urological symptoms. But also cardiovascular symptoms, perception, attention, and sexual function might show beneficial effects when moving from conventional therapies to pump treatment. Further there might be negative influences on some parts of the nonmotor symptomatology through side effects of CSA and LCIG therapy. In this chapter, we review the present knowledge about these aspects of the pump-based therapies. This information might be valuable when deciding on advanced therapy for individual patients.
基于泵的帕金森病（PD）治疗方法，包括皮下注射阿扑吗啡（CSA）和左旋多巴 - 卡比多巴肠凝胶（LCIG），目前是晚期PD最有效的药物治疗方法。这些治疗方法基于多巴胺能药物更持续的输送，从而实现更持续的多巴胺能刺激和更稳定的治疗效果。这可以表现为关期时间减少以及异动症频率和严重程度降低，以及无严重异动症的开期时间增加。现在一些开放标签研究表明，在CSA和LCIG治疗下，非运动性PD症状也可以得到改善。在睡眠、情绪和冷漠、胃肠道症状以及泌尿系统症状方面观察到最一致的改善。但是，从传统治疗转向泵治疗时，心血管症状、感知、注意力和性功能也可能显示出有益效果。此外，CSA和LCIG治疗的副作用可能会对非运动症状的某些方面产生负面影响。在本章中，我们回顾了关于基于泵的治疗方法这些方面的现有知识。这些信息在为个体患者决定晚期治疗时可能很有价值。
