Functional Neuroimaging, Cognitive and Mobility Laboratory, Department of Radiology, University of Michigan, Ann Arbor, MI, USA.
Morris K. Udall Center of Excellence for Parkinson's Disease Research, University of Michigan, Ann Arbor, MI, USA.
Expert Rev Neurother. 2019 Dec;19(12):1229-1251. doi: 10.1080/14737175.2019.1656067. Epub 2019 Aug 30.
: Gait and balance disorders in Parkinson's disease (PD) represent a major therapeutic challenge as frequent falls and freezing of gait impair quality of life and predict mortality. Limited dopaminergic therapy responses implicate non-dopaminergic mechanisms calling for alternative therapies.: The authors provide a review that encompasses pathophysiological changes involved in axial motor impairments in PD, pharmacological approaches, exercise, and physical therapy, improving physical activity levels, invasive and non-invasive neurostimulation, cueing interventions and wearable technology, and cognitive interventions.: There are many promising therapies available that, to a variable degree, affect gait and balance disorders in PD. However, not one therapy is the 'silver bullet' that provides full relief and ultimately meaningfully improves the patient's quality of life. Sedentariness, apathy, and emergence of frailty in advancing PD, especially in the setting of medical comorbidities, are perhaps the biggest threats to experience sustained benefits with any of the available therapeutic options and therefore need to be aggressively treated as early as possible. Multimodal or combination therapies may provide complementary benefits to manage axial motor features in PD, but selection of treatment modalities should be tailored to the individual patient's needs.
帕金森病（PD）中的步态和平衡障碍是一个主要的治疗挑战，因为频繁跌倒和步态冻结会降低生活质量并预测死亡率。有限的多巴胺能治疗反应暗示了非多巴胺能机制，这需要替代疗法。本文作者提供了一篇综述，涵盖了 PD 中与轴性运动障碍相关的病理生理变化、药物治疗方法、运动和物理疗法、提高身体活动水平、侵入性和非侵入性神经刺激、提示干预和可穿戴技术以及认知干预。有许多有前途的治疗方法，在不同程度上可以改善 PD 中的步态和平衡障碍。然而，没有一种疗法是“灵丹妙药”，可以完全缓解这些障碍，并最终显著改善患者的生活质量。久坐不动、冷漠以及 PD 的进展中出现的虚弱，尤其是在存在合并症的情况下，可能是对任何可用治疗选择都能持续获益的最大威胁，因此需要尽早积极治疗。多模式或联合疗法可能会提供额外的益处来治疗 PD 中的轴性运动特征，但治疗方式的选择应根据患者的个体需求进行调整。
