左旋多巴治疗的新进展

2004-6-5 11:54| 发布者: admin| 查看: 5111| 评论: 7|原作者: Peter A. LeWitt, MD;|来自: NEUROLOGY 2004;62(Suppl 1):S9?S16

摘要: 左旋多巴治疗的新进展 Peter A. LeWitt, MD; and Dag Nyholm, MD 文章摘要――30年之后，左旋多巴依旧是PD患者控制症状最有效的药物。尽管已经有大量的药物被用来尝试治疗帕金森病，如多巴胺受体激动剂，COMT抑制剂和MAO-B抑制剂，但大多数患者为更 ...

左旋多巴治疗的新进展
Peter A. LeWitt, MD; and Dag Nyholm, MD

文章摘要――30年之后，左旋多巴依旧是PD患者控制症状最有效的药物。尽管已经有大量的药物被用来尝试治疗帕金森病，如多巴胺受体激动剂，COMT抑制剂和MAO-B抑制剂，但大多数患者为更好的控制症状依旧使用左旋多巴。离体毒性研究的结果提示左旋多巴可能对多巴胺能神经元有毒性作用，但很快被在体研究否定，在体研究表明没有任何毒性作用的证据，相反左旋多巴可能还有神经营养作用。一些文献提到了长期使用左旋多巴会引起运动并发症。目前认为导致此类并发症的主要原因是左旋多巴不稳定的吸收和较短的半衰期所造成的脉冲式多巴胺能刺激。证据表明改变左旋多巴的给药方式，对脑提供连续的药物供给，能更好得控制帕金森病的症状。

NEUROLOGY 2004;62(Suppl 1):S9?S16

New developments in levodopa therapy
Peter A. LeWitt, MD; and Dag Nyholm, MD

Article abstract―More than 30 years after its development, levodopa is still the most effective treatment for the symptomatic control of Parkinson’s disease (PD). Although a number of therapies have been developed in an attempt to improve PD management, such as dopaminergic agonists and inhibitors of COMT and MAO-B, most patients still depend on levodopa alone because of its superior ability to control PD symptoms. The issue of toxicity has been raised by in vitro studies suggesting that levodopa might be toxic to dopaminergic neurons, but this has since been answered by in vivo studies finding no evidence of toxicity and possibly even neurotrophic-like effects. A more pressing concern regarding levodopa is its association with the development of motor complications after long-term use. Pulsatile dopaminergic stimulation as a result of erratic absorption and the short half-life of levodopa have been central issues in attempts to explain this occurrence. Evidence suggests that altering the delivery of levodopa to provide a more continuous supply of this drug to the brain may result in improved control of PD symptoms.