Schelosky L, Poewe W
Department of Neurology, Universitätsklinikum Rudolf Virchow, FU Berlin, Germany.
Acta Neurol Scand Suppl. 1993;146:46-9.
Oral levodopa treatment remains the most efficacious treatment of Parkinson's disease, but the majority of patients treated with a levodopa monotherapy for more than 5 years will develop fluctuations and/or dyskinesias. Important pathophysiological mechanisms are peripheral factors resulting in fluctuating levodopa blood concentrations and central pharmacodynamic changes, possibly due to chronic pulsatile stimulation of dopamine receptors. Continuous dopaminergic stimulation is able to smooth out a fluctuating response to oral levodopa and reduce 'off period' dystonia and the intensity of 'peak dose' dyskinesias. New drug delivery techniques include 'slow release' levodopa preparations and subcutaneous infusions of apomorphine. Future methods of transcutaneous or intramuscular application of dopamine agonists are under development. These methods may help to improve the results of long-term levodopa treatment of parkinsonian patients.
口服左旋多巴治疗仍然是帕金森病最有效的治疗方法，但大多数接受左旋多巴单药治疗超过5年的患者会出现症状波动和/或异动症。重要的病理生理机制是导致左旋多巴血药浓度波动的外周因素以及中枢药效学变化，这可能是由于多巴胺受体的慢性脉冲刺激所致。持续多巴胺能刺激能够消除对口服左旋多巴的波动反应，并减少“关期”肌张力障碍和“峰剂量”异动症的强度。新的给药技术包括“缓释”左旋多巴制剂和皮下注射阿扑吗啡。经皮或肌肉注射多巴胺激动剂的未来方法正在研发中。这些方法可能有助于改善帕金森病患者长期左旋多巴治疗的效果。
