Szász József Attila, Orbán-Kis Károly, Constantin Viorelia Adelina, Péter Csongor, Bíró István, Mihály István, Szegedi Kinga, Balla Antal, Szatmári Szabolcs
University of Medicine and Pharmacy, Târgu Mures¸, Romania,
2nd Neurology Department, Târgu Mures¸ County Emergency Hospital, Târgu Mures¸, Romania.
Neuropsychiatr Dis Treat. 2019 Apr 5;15:831-838. doi: 10.2147/NDT.S197630. eCollection 2019.
In patients older than 70 years there is no valid alternative to progressively introduced substitution therapy. The antiparkinsonian drugs introduced in the last decade to treat Parkinson's disease, especially in its early phases, promised a comparable efficacy in reducing symptoms to levodopa. In younger patients and/or patients with mild symptoms we hoped to delay the motor complications by postponing the start of levodopa therapy. While these assumptions may not be true for all patients, probably the most important current challenge is the optimal starting moment of levodopa therapy. The aim of the study was to analyze the therapeutical choices during the early phase of Parkinson's disease in the Neurological Departments of Târgu Mures¸ County Hospital.
We examined data obtained from hospitalized Parkinson's disease patients during a 15-year period. According to the duration of the disease we split the patients into two groups, patients with Parkinson's disease for less than or equal to 5 years and patients with disease duration longer than 5 years, and then analyzed only the former group.
During the examined period, 2,379 patients with Parkinson's disease were hospitalized, and 1,237 patients had a disease duration shorter than 5 years. In this group, 18 patients had monoamine oxidase inhibitor monotherapy. Also, 665 patients received dopamine agonists, in 120 cases as monotherapy and in 83 patients associated with monoamine oxidase inhibitors. In 521 patients we found only levodopa treatment. A further 481 patients received combined therapy (levodopa with dopamine agonists and/or monoamine oxidase inhibitors).
Treatment strategies for the early stages of Parkinson's disease in our group were comparable to results from other studies. However, the authors feel that neurologists should use levodopa-sparing drugs with greater courage. Furthermore, if the clinical context is appropriate, physicians should combine substitution therapy with other antiparkinsonian drugs in order to reduce levodopa doses.
对于70岁以上的患者，逐步引入替代疗法是唯一有效的选择。过去十年中用于治疗帕金森病的抗帕金森药物，尤其是在疾病早期阶段使用的药物，有望在减轻症状方面达到与左旋多巴相当的疗效。在年轻患者和/或症状较轻的患者中，我们希望通过推迟左旋多巴治疗的开始来延缓运动并发症的出现。虽然这些假设可能并非适用于所有患者，但目前最重要的挑战可能是左旋多巴治疗的最佳起始时机。本研究的目的是分析特尔古穆列什县医院神经科帕金森病早期阶段的治疗选择。
我们检查了15年间住院帕金森病患者的数据。根据疾病持续时间，我们将患者分为两组，帕金森病病程小于或等于5年的患者和病程超过5年的患者，然后仅分析前一组。
在检查期间，2379例帕金森病患者住院，其中1237例病程短于5年。在这组患者中，18例接受单胺氧化酶抑制剂单一疗法。此外，665例患者接受多巴胺激动剂治疗，其中120例为单一疗法，83例与单胺氧化酶抑制剂联合使用。在521例患者中，我们仅发现了左旋多巴治疗。另有481例患者接受联合治疗（左旋多巴与多巴胺激动剂和/或单胺氧化酶抑制剂联合使用）。
我们组帕金森病早期阶段的治疗策略与其他研究结果相当。然而，作者认为神经科医生应更勇敢地使用减少左旋多巴用量的药物。此外，如果临床情况合适，医生应将替代疗法与其他抗帕金森药物联合使用，以减少左旋多巴剂量。
