Department of Neurology, University Medical Center Groningen, University of Groningen, The Netherlands.
Parkinson's Foundation International Centre of Excellence, King's College Hospital, London, UK.
J Parkinsons Dis. 2023;13(5):641-657. doi: 10.3233/JPD-225112.
Oral levodopa is the gold-standard therapy for treating Parkinson's disease (PD) but after a few years of treatment the therapeutic window narrows, and patients often experience various treatment-related complications. Patients in this advanced PD stage may benefit from alternative therapy, such as continuous intrajejunal delivery of levodopa-carbidopa intestinal gel (LCIG; or carbidopa-levodopa enteral suspension), continuous intrajejunal delivery of levodopa-carbidopa-entacapone intestinal gel, or continuous subcutaneous apomorphine infusion. Consideration and initiation of infusion therapies in advanced PD are suggested before the onset of major disability. The present review summarizes clinical evidence for infusion therapy in advanced PD management, discusses available screening tools for advanced PD, and provides considerations around optimal use of infusion therapy.
口服左旋多巴是治疗帕金森病 (PD) 的金标准疗法，但经过几年的治疗后，治疗窗口变窄，患者经常出现各种与治疗相关的并发症。处于晚期 PD 阶段的患者可能受益于替代疗法，例如连续肠内给予左旋多巴-卡比多巴肠凝胶 (LCIG；或卡比多巴-左旋多巴肠混悬液)、连续肠内给予左旋多巴-卡比多巴-恩他卡朋肠凝胶，或持续皮下给予阿朴吗啡输注。建议在出现严重残疾之前考虑并开始对晚期 PD 进行输注治疗。本综述总结了晚期 PD 管理中输注治疗的临床证据，讨论了晚期 PD 的现有筛查工具，并就输注治疗的最佳使用提供了一些考虑。
