Kobylecki Christopher
Manchester Centre for Clinical Neurosciences, Salford, UK and University of Manchester, Manchester, UK.
Clin Med (Lond). 2020 Jul;20(4):393-398. doi: 10.7861/clinmed.2020-0220.
Parkinson's disease (PD) is diagnosed where bradykinesia occurs together with rigidity or tremor, in the presence of supporting features. The diagnosis is clinical, and attention should be paid to exclusion criteria indicating an alternative diagnosis and to 'red flag' features. There is no cure or disease-modifying treatment for PD, and the rate of progression is variable. The most effective symptomatic treatment remains levodopa, which has superior benefits for quality of life in early PD compared to other therapies. Motor fluctuations and dyskinesia later in the disease course can be improved with adjunctive treatments. Around 10% of patients per year with refractory motor fluctuations may be eligible for advanced therapies, including deep-brain stimulation surgery. There is emerging evidence for the management of non-motor symptoms in PD, and the importance of multidisciplinary care. In this article, the evidence base for optimal diagnosis and management of PD is discussed.
帕金森病（PD）的诊断依据是在存在支持性特征的情况下，运动迟缓与僵硬或震颤同时出现。诊断基于临床，应注意排除提示其他诊断的标准以及“警示”特征。目前尚无治愈帕金森病或改变疾病进程的治疗方法，其进展速度因人而异。最有效的对症治疗仍然是左旋多巴，与其他疗法相比，它在帕金森病早期对生活质量有更大益处。疾病后期出现的运动波动和异动症可通过辅助治疗得到改善。每年约10%有难治性运动波动的患者可能适合接受包括脑深部电刺激手术在内的先进疗法。越来越多的证据表明帕金森病非运动症状的管理以及多学科护理的重要性。本文将讨论帕金森病最佳诊断和管理的证据基础。
