Parkinson-Klinik Ortenau, Kreuzbergstr. 12-16, 77723, Wolfach, Germany.
J Neural Transm (Vienna). 2024 Dec;131(12):1471-1480. doi: 10.1007/s00702-024-02825-8. Epub 2024 Sep 11.
Dopamine agonists (DA) have proven very successful in the treatment of Parkinson's disease for a good many years now. In the 1990's they experienced a high level of acceptance particularly in the European countries because their efficacy was in fact established, their tolerability was improved on and, in addition, several preparations were available with longer effect durations. But the discovery of cardiac fibroses led to a substantial setback and even rejection of therapy using ergoline DA. In recent years, impulse control disturbances have been observed increasingly with the result that higher doses have been reduced and the previously popular use of non-ergoline DA was discontinued. In addition, newer data on levodopa were published which clearly relativized the occurrence of late complications under levodopa and led to a differentiated use. Thus the importance of their use has waned over the years. But we should rather avoid repeating the mistakes of the past. DA serve us well and reliably so. The pendulum apparently thrives of the extremes but in the case of DA we should keep from falling back into the other extreme: We can and in fact must further make use of the DA, but with a clear view of specific goals and in a differentiated way. DA constitute the second-most important substance class after levodopa. Their optimized application can only be recommended for the good of our patients.
多巴胺激动剂(DA)在治疗帕金森病方面已经取得了很好的效果,已经有很多年了。在 20 世纪 90 年代,它们在欧洲国家得到了广泛的认可,因为它们的疗效得到了证实,耐受性得到了改善,此外,还有几种具有更长作用持续时间的制剂。但是,心脏纤维性变的发现导致了一个实质性的挫折,甚至拒绝使用麦角 DA 进行治疗。近年来,越来越多的人观察到冲动控制障碍,结果是减少了较高剂量,以前流行的非麦角 DA 也被停用。此外,关于左旋多巴的新数据被公布,这些数据清楚地使左旋多巴引起的晚期并发症的发生变得相对化,并导致了差异化的应用。因此,它们的使用重要性在这些年里已经减弱了。但我们应该避免重蹈过去的覆辙。DA 仍然是可靠的,所以我们应该继续使用它。显然,这种摆动源于极端,但在 DA 的情况下,我们应该避免陷入另一个极端:我们可以而且实际上必须进一步利用 DA,但要有明确的目标和差异化的方式。DA 是除左旋多巴之外第二重要的药物类别。为了我们患者的利益,只有推荐优化其应用。
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