Franke Christiana, Storch Alexander
Charité-Universitätsmedizin Berlin, Berlin, Germany.
University of Rostock, Rostock, Germany; German Centre for Neurodegenerative Diseases (DZNE) Rostock, Rostock, Germany.
Int Rev Neurobiol. 2017;134:947-971. doi: 10.1016/bs.irn.2017.05.021. Epub 2017 Jun 20.
The advanced stage of Parkinson's disease (PD) is characterized by motor complications such as motor fluctuations and dyskinesias induced by long-term levodopa treatment. Recent clinical research provides growing evidence that various nonmotor symptoms such as neuropsychiatric, autonomic, and sensory symptoms (particularly pain) also show fluctuations in patients with motor fluctuations (called nonmotor fluctuations or NMF). However, NMF have not yet been adequately considered in routine care of advanced PD patients and only few therapeutic studies are available. Since the pathophysiology of NMF remains largely unknown, innovative therapeutic concepts are largely missing. The close connection of NMF and motor fluctuations, however, strongly suggests that the strategies used to treat motor complications-namely continuous dopaminergic stimulation-also apply for the therapy of NMF. Future controlled clinical trials specifically addressing NMF are urgently warranted.
帕金森病（PD）晚期的特征是运动并发症，如长期左旋多巴治疗引起的运动波动和异动症。最近的临床研究提供了越来越多的证据表明，各种非运动症状，如神经精神、自主神经和感觉症状（尤其是疼痛）在有运动波动的患者中也会出现波动（称为非运动波动或NMF）。然而，在晚期PD患者的常规护理中，NMF尚未得到充分考虑，仅有少数治疗研究。由于NMF的病理生理学在很大程度上仍然未知，因此基本上缺乏创新的治疗概念。然而，NMF与运动波动的密切联系强烈表明，用于治疗运动并发症的策略——即持续多巴胺能刺激——也适用于NMF的治疗。迫切需要未来专门针对NMF的对照临床试验。
