Szász József Attila, Szatmári Szabolcs, Constantin Viorelia, Mihály István, Török Árpád, Frigy Attila, Metz Júlia, Kelemen Krisztina, Szász Róbert Máté, Forró Timea, Baróti Beáta, Orbán-Kis Károly
1 Marosvásárhelyi "George Emil Palade" Orvosi, Gyógyszerészeti, Tudomány és Technológiai Egyetem, Neurológiai Tanszék 540081 Marosvásárhely, Gral Ion Dumitrache utca 20/A Romania.
2 Maros Megyei Klinikai Sürgősségi Kórház, 2. Sz. Ideggyógyászati Klinika Marosvásárhely Romania.
Orv Hetil. 2022 Jul 24;163(30):1189-1195. doi: 10.1556/650.2022.32534.
Introduction: Parkinson's disease is a neurodegenerative disease, the symptoms of which can be treated reasonably well; however, therapeutic recommendations need to be refined based on the observations from everyday practice. Objective: We aimed to analyze the extent by which published expert recommendations were reflected in the manage-ment of patients with advanced Parkinson's disease, prior to the introduction of the intestinal gel. Method: Data from patients treated with levodopa-carbidopa intestinal gel were retrospectively examined. The period from 2011 to 2021 was divided into two five-year periods, prior and after the usage of the 5-2-1 rule in clinical decision-making. Results: Levodopa-carbidopa intestinal gel treatment was initiated in 150 patients during the study period. In the second five-year period, the mean age of the patients was lower and the time from diagnosis was shorter. Also, there were significantly fewer patients with peak-dose dyskinesias (p = 0.02), biphasic dyskinesias (p<0.001), and early morning akinesias (p = 0.02). Furthermore, in the last five years of the study, fewer patients were affected by delayed on (p = 0.03), no on (p = 0.02), and freezing (p = 0.01). The mean score measured on the Hoehn-Yahr scale was also lower in the second period, while the mean MMSE score was higher (p<0.001). Daily doses of levodopa were higher (p<0.01) in the second period, but with similar dosing frequency. Conclusion: Our retrospective analysis of trends during a ten-year period revealed that, in the second five-year period, levodopa-carbidopa intestinal gel was started in advanced Parkinson's disease patients with a significantly better physical and cognitive state. Compared to expert recommendations, our patients still had a more severe clinical pic -ture at the start of device-aided therapy, but acceptance of this invasive method has improved both for patients and for general practitioners and neurologists.
帕金森病是一种神经退行性疾病，其症状可以得到较好的合理治疗；然而，治疗建议需要根据日常实践中的观察结果进行完善。目的：我们旨在分析在引入肠道凝胶之前，已发表的专家建议在晚期帕金森病患者管理中的体现程度。方法：回顾性研究左旋多巴 - 卡比多巴肠道凝胶治疗患者的数据。2011年至2021年期间分为两个五年期，即临床决策中使用5 - 2 - 1规则之前和之后。结果：在研究期间，150例患者开始接受左旋多巴 - 卡比多巴肠道凝胶治疗。在第二个五年期，患者的平均年龄较低，从诊断到治疗的时间较短。此外，出现剂峰异动症（p = 0.02）、双相异动症（p<0.001）和清晨运动不能（p = 0.02）的患者明显减少。此外，在研究的最后五年中，出现起效延迟（p = 0.03）、无起效（p = 0.02）和冻结现象（p = 0.01）的患者较少。第二个时期Hoehn - Yahr量表的平均评分也较低，而平均MMSE评分较高（p<0.001）。第二个时期左旋多巴的每日剂量较高（p<0.01），但给药频率相似。结论：我们对十年期间趋势的回顾性分析表明，在第二个五年期，晚期帕金森病患者开始使用左旋多巴 - 卡比多巴肠道凝胶时，其身体和认知状态明显更好。与专家建议相比，我们的患者在器械辅助治疗开始时临床症状仍更严重，但患者以及全科医生和神经科医生对这种侵入性方法的接受度有所提高。
