| AAN2001年发布的新发PD治疗的循证指南 Quality Standards Subcommittee of AAN 摘要――美国神经学学会1993年制定的帕金森病药物治疗循证指南中指出左旋多巴是治疗此疾病的最有效的药物。从那以后，又有大量的新药被开发和研究，其中包括非麦角碱类的多巴胺激动剂（DA）和缓释左旋多巴。因此，对于新发PD患者的治疗观点需要重新评估。这些问题包括：1）司来吉兰（selegiline）是否有神经保护作用。2）在新发病人中对症治疗的最佳方案；和3）相对普通的左旋多巴，对于新发PD患者，缓释左旋多巴是否能获得更大的益处？基于循证医学的基础，使用MEDLINE，EMBASE和Cochrane Library数据库对1966至1999的所有新发PD病人的临床试验进行文献检索，仅收集有class I或class II证据的文献。 基于这个回顾性总结，我们得出以下结论：1）司来吉兰（selegiline）有非常轻微的控制症状作用（level A, class II证据），但没有证据表明其有神经保护作用（level U, class II证据）。2）对于需要开始控制症状治疗的PD患者，无论左旋多巴还是DA都能使用（level A, class I and class II证据）。左旋多巴能获得更好的症状控制效果但也伴随着更大的运动障碍危险。3）没有证据表明最初就使用缓释左旋多巴能比普通左旋多巴制剂给病人带来更多的益处（level B, class II证据）。 NEUROLOGY 2002;58:11?17 Practice parameter: Initiation of treatment for Parkinson’s disease: An evidence-based review Report of the Quality Standards Subcommittee of the American Academy of Neurology Abstract―In 1993, the last AAN Practice Parameter on medical treatment of Parkinson’s disease (PD) concluded that levodopa was the most effective drug for management of this disorder. Since then, a number of new compounds including non-ergot dopamine agonists (DA) and sustained-release levodopa have been released and studied. Thus, the issue of treatment in de novo PD patients warrants reexamination. Specific questions include: 1) does selegiline offer neuroprotection; 2) what is the best agent with which to initiate symptomatic treatment in de novo PD; and 3) is there a benefit of sustained release levodopa over immediate-release levodopa? Using evidence-based principles, a literature review using MEDLINE, EMBASE, and the Cochrane Library was performed to identify all human trials in de novo PD between 1966 and 1999. Only articles that fulfilled class I or class II evidence were included. Based on this review, the authors conclude: 1) Selegiline has very mild symptomatic benefit (level A, class II evidence) with no evidence for neuroprotective benefit (level U, class II evidence). 2) For PD patients requiring initiation of symptomatic therapy, either levodopa or a DA can be used (level A, class I and class II evidence). Levodopa provides superior motor benefit but is associated with a higher risk of dyskinesia. 3) No evidence was found that initiating treatment with sustained-release levodopa provides an advantage over immediate-release levodopa (level B, class II evidence). NEUROLOGY 2002;58:11?17 |
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