MedStar Georgetown University Hospital, Neurology Department, Reservoir Rd, Washington, DC, United States.
MedStar Georgetown University Hospital, Neurology Department, Reservoir Rd, Washington, DC, United States.
Int Rev Neurobiol. 2023;170:105-119. doi: 10.1016/bs.irn.2023.06.004. Epub 2023 Jul 3.
Although there is no cure for Parkinson's disease (PD), there are several classes of medications with various mechanisms of action that can help improve the functionality of someone with PD. Dopamine derivatives are first line therapies for PD, hence dopamine receptor agonists (DAs) have been shown to improve functionality of symptoms in PD patients. The two main formulations of dopamine agonist medications in PD therapy are ergoline and non-ergoline derivatives. Additionally, it has been shown that PD can involve irregularities in other neurotransmitters, such as acetylcholine, norepinephrine, and serotonin, hence why non-dopaminergic medications are also vital in PD management. Examples include NMDA receptor antagonists, dopamine antagonists (i.e. neuroleptics), acetylcholine receptor antagonists, serotonin receptor 2A agonists, and adenosine A antagonists. In general, dopaminergic medications are the most effective in improving motor involvement with PD, whereas non-dopaminergic medications tend to focus on the non-motor involvement of PD. In this chapter, we will focus on the chemistry and medication background on dopaminergic vs non-dopaminergic therapy, with a focus of adenosine A antagonists at the end.
虽然没有治愈帕金森病 (PD) 的方法,但有几类具有不同作用机制的药物可以帮助改善 PD 患者的功能。多巴胺衍生物是 PD 的一线治疗药物,因此多巴胺受体激动剂 (DAs) 已被证明可以改善 PD 患者的症状功能。PD 治疗中多巴胺激动剂药物的两种主要制剂是麦角碱和非麦角碱衍生物。此外,已经表明 PD 可能涉及其他神经递质(如乙酰胆碱、去甲肾上腺素和血清素)的不规则,因此非多巴胺能药物在 PD 管理中也至关重要。例如 NMDA 受体拮抗剂、多巴胺拮抗剂(即神经阻滞剂)、乙酰胆碱受体拮抗剂、血清素受体 2A 激动剂和腺苷 A 拮抗剂。一般来说,多巴胺能药物在改善 PD 的运动参与方面最有效,而非多巴胺能药物则倾向于关注 PD 的非运动参与。在本章中,我们将重点介绍多巴胺能与非多巴胺能治疗的化学和药物背景,最后重点介绍腺苷 A 拮抗剂。