Poewe W
Department of Neurology, University Hospital Innsbruck, Austria.
Neurology. 1998 Jun;50(6 Suppl 6):S23-6; discussion S44-8. doi: 10.1212/wnl.50.6_suppl_6.s23.
The classical role of dopamine agonists in Parkinson's disease (PD) therapy is adjunctive treatment to levodopa once "wearing-off" fluctuations or more malignant types of "on-off" swings have developed. Dopamine agonists reduce the frequency, severity, and duration of "off" periods while allowing the levodopa dose to be reduced. Interest is growing in the role of dopamine agonists as primary monotherapy in PD. Studies of early monotherapy have shown that, even with sustained treatment, drug-induced dyskinesias rarely develop. However, this approach is successful for more than 3 years in only about 30% of all PD patients. Continuous dopaminergic stimulation via subcutaneous dopamine agonist infusions is being investigated as a way to control levodopa-associated peak-dose dyskinesias. Early combined treatment with levodopa has been suggested as effective while avoiding long-term complications, but the therapy remains controversial. Despite the entry of several new dopamine agonists into clinical practice, the ideal agonist, with long duration of action and efficacy equal to that of levodopa, is still lacking. The clinical pharmacology of dopamine agonists is reviewed.
多巴胺激动剂在帕金森病（PD）治疗中的经典作用是，一旦出现“剂末”波动或更严重的“开-关”波动，就作为左旋多巴的辅助治疗。多巴胺激动剂可减少“关”期的频率、严重程度和持续时间，同时可减少左旋多巴的剂量。多巴胺激动剂作为PD的初始单一疗法的作用正日益受到关注。早期单一疗法的研究表明，即使持续治疗，药物性异动症也很少发生。然而，在所有PD患者中，只有约30%的患者采用这种方法能成功超过3年。通过皮下输注多巴胺激动剂进行持续多巴胺能刺激，正作为一种控制左旋多巴相关的峰剂量异动症的方法进行研究。有人提出早期联合使用左旋多巴治疗有效，同时可避免长期并发症，但该疗法仍存在争议。尽管有几种新多巴胺激动剂已进入临床应用，但仍缺乏作用持续时间长且疗效与左旋多巴相当的理想激动剂。本文对多巴胺激动剂的临床药理学进行综述。
