Lieberman A N, Goldstein M, Gopinathan G, Neophytides A
New York University School of Medicine, New York.
Can J Neurol Sci. 1987 Aug;14(3 Suppl):466-73. doi: 10.1017/s0317167100037938.
We have evaluated 5 DA agonists-bromocriptine, lergotrile, lisuride, pergolide, and mesulergine in studies encompassing 278 patients with advanced PD. In most of our patients the DA agonist was added to levodopa. Most of our patients were no longer satisfactorily responding to levodopa. Previous attempts at managing these patients by changing the dose of levodopa (increasing or decreasing it), the treatment schedule, or the ratio of levodopa to carbidopa or by temporarily discontinuing levodopa [drug holiday] were unsuccessful. The majority of our patients had diurnal fluctuations in performance, either "wearing off" or "on-off" phenomena. The addition of a DA agonist resulted in a decrease in parkinsonian disability in most patients and a decrease in the severity of the diurnal fluctuations in performance. Improvement in many patients was maintained for at least 2 years. Adverse effects included mental changes, dyskinesias, orthostatic hypotension, and nausea. All of the adverse effects were reversible when the agonist was decreased or discontinued. As a group the agonists behaved similarly but individual patients often responded better to one agonist than another. The main role of agonists is in combination with levodopa in the treatment of patients with early PD who have not yet developed dyskinesias or diurnal fluctuations in performance.
我们在涉及278例晚期帕金森病（PD）患者的研究中评估了5种多巴胺（DA）激动剂——溴隐亭、麦角腈、利舒脲、培高利特和甲磺酸麦角乙脲。在我们的大多数患者中，DA激动剂是添加到左旋多巴治疗方案中的。我们的大多数患者对左旋多巴已不再有令人满意的反应。此前通过改变左旋多巴剂量（增加或减少）、治疗方案、左旋多巴与卡比多巴的比例或暂时停用左旋多巴[药物假期]来管理这些患者的尝试均未成功。我们的大多数患者存在日间功能波动，即“疗效减退”或“开-关”现象。添加DA激动剂使大多数患者的帕金森病残疾程度降低，且日间功能波动的严重程度减轻。许多患者的病情改善持续了至少2年。不良反应包括精神改变、运动障碍、体位性低血压和恶心。当减少或停用激动剂时，所有不良反应均可逆转。作为一个整体，这些激动剂的表现相似，但个别患者对一种激动剂的反应往往比对另一种更好。激动剂的主要作用是与左旋多巴联合用于治疗尚未出现运动障碍或日间功能波动的早期PD患者。
