Boshes B
Ann Intern Med. 1981 Mar;94(3):364-70. doi: 10.7326/0003-4819-94-3-364.
Sinemet (a combination of levodopa with carbidopa, a dopa-decarboxylase inhibitor) has replaced levodopa for early treatment of parkinsonism. The blocking of the systemic uptake of dopamine has eliminated the previous complications of nausea, vomiting, and cardiac and respiratory arrhythmias; pyridoxine need not now be avoided. However, the earlier appearance of abnormal involuntary movements, hallucinations, occasional psychosis, and a dopa-resistant state limits treatment efficacy. In all-over experience the combination drug offers the best relief for rigidity and akinesia. It has improved the quality of life and reduced mortality by one half. The greatest benefits appear in the first 3 years; then complications set in. The relation of complications to dosage is now better understood, and the ratio of dopa-decarboxylase inhibitor to levodopa inhibitor to levodopa of 1:4 is better than the previous 1:10. Levodopa with or without dopa decarboxylase is not a cure for parkinsonism. Some agonist drugs (bromocryptine, lisuride) are showing promise in the testing stage. The evolving knowledge about neurotransmitters and peptide messengers offers hope for the growing number of patients with parkinsonism.
息宁（左旋多巴与多巴脱羧酶抑制剂卡比多巴的复方制剂）已取代左旋多巴用于帕金森病的早期治疗。阻断多巴胺的全身摄取消除了以往恶心、呕吐以及心脏和呼吸心律失常等并发症；现在无需避免使用吡哆醇。然而，异常不自主运动、幻觉、偶发精神病以及多巴胺抵抗状态较早出现限制了治疗效果。从总体经验来看，复方药物对强直和运动不能的缓解效果最佳。它改善了生活质量，并使死亡率降低了一半。最大益处出现在最初3年；随后并发症出现。现在对并发症与剂量的关系有了更好的理解，多巴脱羧酶抑制剂与左旋多巴1:4的比例优于之前的1:10。左旋多巴无论有无多巴脱羧酶都不能治愈帕金森病。一些激动剂药物（溴隐亭、利苏瑞）在试验阶段显示出前景。关于神经递质和肽类信使不断发展的知识为越来越多的帕金森病患者带来了希望。
