左旋多巴是改善帕金森病运动症状最为有效的药物,但是长期应用引发的运动并发症也是治疗中最棘手的问题.业已证实,一些危险因素可能参与了运动并发症的发生机制.明确危险因素、具有针对性地采取有效治疗措施可能有益于延缓运动并发症的发生.在病程不同时期,拟多巴胺类药物种类和服药时间的选择也可能有一定影响.然而,当前传统口服药物治疗方式尚不能治愈运动并发症,皮下注射阿朴吗啡、持续肠道微量泵控输注左旋多巴或丘脑底核电刺激术在病程晚期可能有效.近年来,一些非拟多巴胺类药物已经成为运动并发症治疗的新方向,但结论尚不一致.运动并发症的临床治疗是一个长期过程,各个阶段治疗策略应根据需求不同而进行调整.%Currently,levodopa remains to be the most effective agent to improve motor symptoms in Parkinson's disease (PD).However,the chronic use is associated with the emergence of motor fluctuations,which has been one of the most troublesome dilemmas in PD's treatment.A plenty of clinical studies evidenced some risk factors would contribute to the emergence of the motor complications.Therefore,a better understanding of these risk factors may help to draw up the preventive strategies to target "at risk"populations before the onset of motor complications.Therapeutic strategies using different types and timing of dopaminergic therapy may influence the emergence of motor complications.Unfortunately,the traditional oral treatments for motor complications are only partially effective,rarely abolishing motor complications.The clinical improvement might be achieved with invasive strategies via subcutaneous or intraduodenal delivery of apomorphine or levodopa,or deep brain stimulation (DBS) of the subthalamic nucleus,especially at late stage of PD.Besides,targeting transmitter systems beyond the dopamine system is another interesting approach for the motor complications of PD.However,clinical trail evidence regarding the medicine has been inconsistent.The treatment of motor complications is a long-term project,and the strategies should be modified to solve the demands at different stages.
展开▼
