Ahlskog J E
Department of Neurology, Mayo Clinic, Rochester, MN 55905.
Postgrad Med. 1994 Apr;95(5):52-4, 57-8, 61-4 passim.
Parkinson's disease responds rather dramatically to levodopa therapy during the first several years of treatment. With advancing disease, however, symptom control becomes more erratic, and some symptoms may become refractory to treatment. The use of selegiline hydrochloride (Eldepryl) has been proposed to slow the progression of Parkinson's disease; however, current evidence suggests that it is only partially effective at best, and there is no definite proof of a neuroprotective effect. Nonetheless, it is a reasonable treatment choice. Carbidopa-levodopa (Sinemet) remains the foundation of symptomatic treatment of Parkinson's disease. Clinical fluctuations occurring with advancing disease may be at least partially controlled by appropriate adjustments in dosage. A direct-acting dopamine agonist, bromocriptine mesylate (Parlodel) or pergolide mesylate (Permax), can be very helpful as adjunctive therapy to smooth these clinical fluctuations. Excessive intracellular oxidative stress has been proposed as a cause of Parkinson's disease; however, a recent multicenter trial investigating the use of high doses of the antioxidant vitamin E showed it to be ineffective. Whether other forms of nonspecific antioxidant therapy will prove beneficial is open to speculation.
在帕金森病治疗的最初几年，左旋多巴疗法对其有显著疗效。然而，随着病情进展，症状控制变得更加不稳定，一些症状可能对治疗产生耐药性。已有人提出使用盐酸司来吉兰（ Eldepryl）来减缓帕金森病的进展；然而，目前的证据表明，它充其量只是部分有效，而且没有明确证据证明其具有神经保护作用。尽管如此，它仍是一种合理的治疗选择。卡比多巴 - 左旋多巴（息宁）仍然是帕金森病症状性治疗的基础。随着病情进展出现的临床波动，可通过适当调整剂量至少部分得到控制。直接作用的多巴胺激动剂，甲磺酸溴隐亭（ Parlodel）或甲磺酸培高利特（ Permax），作为辅助治疗以缓解这些临床波动可能非常有帮助。有人提出细胞内过度氧化应激是帕金森病的一个病因；然而，最近一项研究大剂量抗氧化剂维生素E使用情况的多中心试验表明它无效。其他形式的非特异性抗氧化疗法是否有益仍有待推测。
