Szász József Attila, Szatmári Szabolcs, Constantin Viorelia, Mihály István, Rácz Attila, Domokos Lajos Csaba, Vajda Tamás, Orbán-Kis Károly
Marosvásárhelyi Orvosi és Gyógyszerészeti Egyetem Strada Gheorghe Marinescu 38, Târgu Mureș 540139, Románia.
2. Sz. Ideggyógyászati Klinika, Maros Megyei Sürgősségi Kórház Marosvásárhely, Románia.
Orv Hetil. 2019 Apr;160(17):662-669. doi: 10.1556/650.2019.31354.
The motor and non-motor complications of Parkinson's disease impair the patients' quality of life and limit therapeutical options. There are no clear criteria for 'advanced' Parkinson's disease or for the optimal moment for invasive therapies. There is little evidence regarding the upper limits of levodopa doses, and how these may be influenced by the availability of device-aided therapies. To analyze substitution therapy in patients with advanced Parkinson's disease. In our retrospective study, we analyzed the data from all patients with advanced Parkinson's disease hospitalized between 1st June 2011 and 31st May 2017, receiving combined levodopa treatment at least 4×/day, reporting a minimum of 2 hours periods, with or without dyskinesia. We analyzed levodopa therapy for patients who were recommended either device-aided or conservative therapy. Out of 311 patients with advanced Parkinson's disease, for 125 we proposed device-aided therapies whereas in 42 patients we increased the levodopa dose. The average levodopa doses and the administration rate were higher for the 107 patients tested for levodopa-carbidopa intestinal gel. Disease duration, mean levodopa doses and frequency of dosing were all higher in patients proposed for device-aided therapies patients with continued conservative treatment. Our patients were on lower levodopa doses (compared to literature), but the combinations were used more often. Device-aided therapies should be considered in patients with severe motor complications who receive at least 750-1000 mg levodopa daily, divided minimum 5×/day. These patients need to be tested in specialized centers by multidisciplinary teams in order to make the best decision for further action. Orv Hetil. 2019; 160(17): 662-669.
帕金森病的运动和非运动并发症会损害患者的生活质量，并限制治疗选择。对于“晚期”帕金森病或侵入性治疗的最佳时机，目前尚无明确标准。关于左旋多巴剂量的上限以及这些上限如何受到器械辅助治疗可用性的影响，证据很少。目的是分析晚期帕金森病患者的替代治疗。在我们的回顾性研究中，我们分析了2011年6月1日至2017年5月31日期间住院的所有晚期帕金森病患者的数据，这些患者接受至少每日4次的左旋多巴联合治疗，报告至少2小时的时间段，有或没有异动症。我们分析了被推荐接受器械辅助治疗或保守治疗的患者的左旋多巴治疗情况。在311例晚期帕金森病患者中，我们为125例患者建议了器械辅助治疗，而在42例患者中增加了左旋多巴剂量。接受左旋多巴-卡比多巴肠凝胶测试的107例患者的平均左旋多巴剂量和给药率更高。与继续接受保守治疗的患者相比，建议接受器械辅助治疗的患者的病程、平均左旋多巴剂量和给药频率都更高。我们的患者左旋多巴剂量较低（与文献相比），但联合用药更为频繁。对于每天接受至少750 - 1000毫克左旋多巴、至少每日5次给药的严重运动并发症患者，应考虑器械辅助治疗。这些患者需要在专业中心由多学科团队进行测试，以便为进一步行动做出最佳决策。《匈牙利医学周报》。2019年；160(17): 662 - 669。
