Department of Neuroscience, University of Padua, Padua, Italy.
Division of Neurology, CHU of Grenoble, Grenoble Alpes University, Grenoble, France.
Mov Disord. 2018 Jul;33(6):900-908. doi: 10.1002/mds.27340. Epub 2018 Mar 23.
Advanced Parkinson's disease is characterized by the presence of motor fluctuations, various degree of dyskinesia, and disability with functional impact on activities of daily living and independence. Therapeutic management aims to extend levodopa benefit while minimizing motor complications and includes, in selected cases, the implementation of drug infusion and surgical techniques. In milder forms of motor complications, these can often be controlled with manipulation of levodopa dose and the introduction of supplemental therapies such as catechol-O-methyl transferase inhibitors, monoamine oxidase B inhibitors, and dopamine agonists including apomorphine. Clinical experience and evidence from published studies indicate that when these agents cannot satisfactorily control motor complications, patients should be assessed and considered for device-aided therapies. This review article summarizes some of the newer available therapeutic opportunities such as use of enzyme inhibitors like opicapone and safinamide, adenosine A receptor antagonists, apomorphine and levodopa/carbidopa intestinal gel infusion, deep brain stimulation including the role of closed-loop and adaptive stimulation, and MRI-guided focused ultrasound. © 2018 International Parkinson and Movement Disorder Society.
晚期帕金森病的特征是存在运动波动、不同程度的运动障碍以及对日常生活活动和独立性有功能影响的残疾。治疗管理旨在延长左旋多巴的疗效，同时最大限度地减少运动并发症，包括在选定的情况下实施药物输注和手术技术。在运动并发症的较轻形式中，这些并发症通常可以通过操纵左旋多巴剂量和引入补充疗法（如儿茶酚-O-甲基转移酶抑制剂、单胺氧化酶 B 抑制剂和多巴胺激动剂，包括阿扑吗啡）来控制。临床经验和已发表研究的证据表明，当这些药物不能令人满意地控制运动并发症时，应评估患者并考虑为其提供设备辅助治疗。本文综述了一些较新的治疗机会，如使用酶抑制剂（如托卡朋和沙芬酰胺）、腺苷 A 受体拮抗剂、阿扑吗啡和左旋多巴/卡比多巴肠内凝胶输注、包括闭环和适应性刺激作用的深部脑刺激，以及 MRI 引导聚焦超声。© 2018 国际帕金森病和运动障碍协会。
