Georgiev Dejan, Trost Maja
Department of Neurology, University Medical Centre Ljubljana, Ljubljana, Slovenia.
Artificial Intelligence Lab, Faculty of Computer and Information Science, University of Ljubljana, Ljubljana, Slovenia.
Neurol Neurochir Pol. 2025;59(2):111-126. doi: 10.5603/pjnns.102858. Epub 2025 Jan 9.
In the advanced stages of Parkinson's disease (PD), when standard drug adjustments fail to sufficiently improve patients' quality of life, device-aided therapies (DATs) such as deep brain stimulation (DBS), continuous subcutaneous apomorphine infusion (CSAI), levodopa-carbidopa intestinal gel infusion (LCIG), levodopa-carbidopa-entacapone intestinal gel infusion, or continuous subcutaneous foslevodoa-foscarbidopa infusion are beneficial in the long run. However, sometimes patients need to switch or combine DATs due to either adverse events or loss of efficacy.
The aim of this article was to summarise the existing data on the long-term efficacy and adverse events of DATs, and to review the data on the rationale and efficacy for switching or combining DATs in advanced PD.
A total of 50 studies on the long-term efficacy of DBS (N = 28), LCIG (N = 12), CSAI (N = 10) and 13 studies on switching and combining DATs were included in this review. Although the DATs show a favourable long-term effect on the main motor and non-motor symptoms of PD they all feature specific adverse events that need to be considered when deciding which DAT to offer to a particular patient. Occasionally, switching or combining DATs is recommended, e.g. if the first DAT shows inadequate symptom control, or due to adverse events. The choice of the second DAT depends above all on the main problems of the first DAT being correctly recognised.
DATs are a safe and long-term effective option for the treatment of advanced PD. Switching and/or combining DATs is recommended for patients in whom the first treatment option is not optimal.
Future studies are warranted to address the unresolved issues related to long-term efficacy, side effect profile and switching and combination of DATs in multicentric studies and using advanced analytical approaches such as machine learning.
在帕金森病（PD）的晚期，当标准药物调整无法充分改善患者生活质量时，从长远来看，诸如深部脑刺激（DBS）、皮下持续阿扑吗啡输注（CSAI）、左旋多巴 - 卡比多巴肠凝胶输注（LCIG）、左旋多巴 - 卡比多巴 - 恩他卡朋肠凝胶输注或皮下持续福司左旋多巴 - 福司卡比多巴输注等器械辅助治疗（DATs）是有益的。然而，有时患者由于不良事件或疗效丧失需要更换或联合使用DATs。
本文旨在总结关于DATs长期疗效和不良事件的现有数据，并回顾晚期PD患者更换或联合使用DATs的理论依据和疗效数据。
本综述纳入了共50项关于DBS（N = 28）、LCIG（N = 12）、CSAI（N = 10）长期疗效的研究以及13项关于更换和联合使用DATs的研究。尽管DATs对PD的主要运动和非运动症状显示出良好的长期效果，但它们都有特定的不良事件，在决定为特定患者提供哪种DAT时需要考虑这些不良事件。偶尔，建议更换或联合使用DATs，例如，如果第一种DAT显示症状控制不足，或由于不良事件。第二种DAT的选择首先取决于能否正确识别第一种DAT的主要问题。
DATs是治疗晚期PD的一种安全且长期有效的选择。对于第一种治疗方案不理想的患者，建议更换和/或联合使用DATs。
未来有必要开展研究，通过多中心研究并使用机器学习等先进分析方法，解决与DATs的长期疗效、副作用特征以及更换和联合使用相关的未解决问题。
