Erwin W G, Turco T F
Clin Pharm. 1986 Sep;5(9):742-53.
The etiology, pathophysiology, diagnosis and clinical presentation, and clinical management of Parkinson's disease are reviewed. The cause of Parkinson's disease, a progressive, degenerative neurologic motor disorder, is unknown. Both endogenous and environmental factors appear to play a role. The clinical features of parkinsonism result from a depletion in dopaminergic transmission in the corpus striatum; the dopamine deficiency is caused by a loss of melanin-containing nerve cells within the substantia nigra and locus ceruleus. In the remaining neurons, hyalin-like masses called Lewy bodies increase in number, but the importance of this is unclear. The diagnosis of Parkinson's disease is based on the clinical presentation of the patient, which initially includes sensory complaints of aching pains, paresthesias, numbness, and coldness. As the disease progresses, the four classic symptoms become prominent: tremor, rigidity, bradykinesia, and postural difficulties. Drug therapy is the cornerstone of clinical management of Parkinson's disease, but no treatment has been found that will retard or reverse the disease. Therapy is usually initiated with anticholinergic agents such as biperiden hydrochloride or trihexyphenidyl hydrochloride with or without amantadine. The mainstay of therapy is levodopa, which is used in combination with dopa decarboxylase inhibitors to decrease the peripheral conversion of levodopa to dopamine. Bromocriptine is a dopamine agonist useful in treating Parkinson's disease. Therapy, which must continue for life, eventually becomes less effective or completely ineffective in all patients. Drug therapy has improved greatly the functional ability of patients with Parkinson's disease, but new agents that can extend the length of effective treatment or reverse the disease are needed.
本文综述了帕金森病的病因、病理生理学、诊断、临床表现及临床管理。帕金森病是一种进行性、退行性神经运动障碍，其病因尚不清楚。内源性和环境因素似乎都起作用。帕金森综合征的临床特征是纹状体多巴胺能传递减少所致；多巴胺缺乏是由黑质和蓝斑内含黑色素的神经细胞丢失引起的。在其余神经元中，称为路易小体的透明样物质数量增加，但其重要性尚不清楚。帕金森病的诊断基于患者的临床表现，最初包括疼痛、感觉异常、麻木和寒冷等感觉方面的主诉。随着疾病进展，四种典型症状变得突出：震颤、僵硬、运动迟缓及姿势障碍。药物治疗是帕金森病临床管理的基石，但尚未发现能延缓或逆转该病的治疗方法。治疗通常从抗胆碱能药物开始，如盐酸苯海索或盐酸三己芬迪，可加用或不加用金刚烷胺。治疗的主要药物是左旋多巴，它与多巴脱羧酶抑制剂联合使用，以减少左旋多巴在外周转化为多巴胺。溴隐亭是一种可用于治疗帕金森病的多巴胺激动剂。治疗必须终身持续，但最终在所有患者中都会变得效果降低或完全无效。药物治疗极大地改善了帕金森病患者的功能能力，但仍需要能延长有效治疗时间或逆转该病的新药物。
