Therapy guided by symptoms for Parkinson's disease

Low-dose combinations of medications that work in slightly different ways constitute optimal management of Parkinson's disease. Surgical approaches are being perfected for patients who stop responding favorably to pharmacologic treatment.     

左旋多巴剂量与帕金森病异动症风险的相关性分析

目的探讨帕金森病(Parkinson's disease,PD)患者既往服用左旋多巴情况与异动症风险的相关性,并基于数据驱动方法分析PD患者左旋多巴每日最高安全剂量以及累积安全剂量。方法选择于2017年3～12月于我院住院的PD患者142例,将伴发异动症患者41例作为异动组,不伴异动症患者101例作为非异动组。logistic回归分析PD患者服用左旋多巴情况与异动症风险的相关性;利用分类决策树模型计算左旋多巴安全剂量。结果异动组病程、服用药物时间明显高于非异动组,发病年龄和体质量明显低于非异动组。异动组左旋多巴累积剂量和峰日剂量明显高于非异动组[(949.10±750.39)g vs (510.77±428.36)g,P0.01;(639.81±363.87)mg/d vs(381.93±169.89)mg/d,P0.01]。logistic回归分析显示,左旋多巴累积剂量和峰日剂量与PD异动症风险均具有相关性(OR=1.002,P=0.002;OR=1.006,P=0.000)。分类决策树模型预测提示,左旋多巴峰日剂量400.00mg/d、左旋多巴累积剂量609.75g为区分异动症与非异动症的安全剂量。结论左旋多巴峰日剂量和累积剂量与PD异动风险可能具有相关性。     

帕金森病异动症危险因素及左旋多巴安全剂量的数据驱动分析

目的探讨帕金森病(Parkinson's disease,PD)异动症的临床危险因素,并基于数据驱动方法分析PD患者异动症的左旋多巴安全剂量。方法选择2012年3月~2013年7月在首都医科大学附属北京天坛医院神经变性病科住院的PD患者163例,其中伴发异动症患者20例(异动组),不伴异动症患者143例(非异动组)。logistic回归分析PD异动症潜在危险因素;利用分类决策树模型计算左旋多巴安全剂量。结果异动组病程、Hoehn-Yahr(H-Y)分期、统一PD评定量表(UPDRS)Ⅰ、UPDRSⅡ、UPDRSⅢ、UPDRSⅣ、左旋多巴等效剂量、左旋多巴、多巴受体激动剂、抗胆碱能药、恩他卡朋、金刚烷胺比例明显高于非异动组(P0.05,P0.01),起病年龄[(51.8±14.3)岁vs(59.2±10.8)岁,P=0.007]明显低于非异动组。logistic回归分析显示,H-Y分期(HR=3.544,P=0.047)、病程(HR=1.233,P=0.033)为PD异动症的危险因素,其中左旋多巴等效剂量(P=0.055)为可能的危险因素。分类决策树模型预测提示,左旋多巴等效剂量387.5mg/d为区别异动组与非异动组的左旋多巴安全剂量。结论 PD异动症可能与左旋多巴等效剂量、运动症状严重程度、病程有关。     

老年帕金森病康复

帕金森病（PD）是一种发生于老年人的中枢神经系统锥体外系慢性进展性变性疾病,其确切病因不明,主要病理变化是黑质致密部的多巴胺（DA）能神经元变性、凋亡,临床主要表现运动缓慢、肌强直和静止性震颤以及植物神经功能障碍和心理障碍。     

Gene therapy for Parkinson's disease

INTRODUCTION: Parkinson's disease is a progressive neurodegenerative disorder whose main histopathological feature is the loss of dopaminergic neurons in the pars compacta of the substantia nigra with secondary striatal dopaminergic insufficiency. Treatment relies on medical therapy, using levodopa and dopaminergic agonists. However, the development of treatment complications, including motor fluctuations and levodopa-induced dyskinesia, led to the development of alternative therapeutical strategies such as deep brain stimulation and gene therapy. EXEGESIS: Current gene therapy models for Parkinson's disease have focused on two strategies. The first one is the replacement of biosynthetic enzymes for dopamine synthesis and the second consists in the addition of neurotrophic factors for protection and restoration of dopaminergic neurons. CONCLUSION: Neuroprotection and restoration of the nigrostriatal pathway are important issues for future genetic treatment strategies for Parkinson's disease and could include, in addition to neurotrophic factors, genes to prevent apoptosis or detoxify free radical species.     

Recent Advances in Drug Therapy for Parkinson's Disease

Parkinson''s disease (PD) is a neurodegenerative disease manifesting with motor and non-motor symptoms. Current treatment mainly relies on medication as a symptomatic therapy modulating neurotransmitters. Dopamine replacement therapy has been established, and levodopa is the gold standard for treatment of PD. However, the emergence of motor complications, such as a wearing-off phenomenon, is a clinical problem. Both primary symptoms and motor complications have been targets for the development of treatments for PD. Recent progression in the management of motor complications is supported by newly developed agents and advances in device and formulation technology to deliver drugs continuously. Elucidation of the pathophysiology of PD and the development of disease-modifying therapy that affects the underlying fundamental pathophysiology of the disease are also progressing. In this review, we introduce current knowledge on developments concerning medications for patients with PD.     

Parkinson's disease

Parkinson's disease is the most common serious movement disorder in the world, affecting about 1% of adults older than 60 years. The disease is attributed to selective loss of neurons in the substantia nigra, and its cause is enigmatic in most individuals. Symptoms of Parkinson's disease respond in varying degrees to drugs, and surgery offers hope for patients no longer adequately controlled in this manner. The high prevalence of the disease, and important advances in its management, mean that generalists need to have a working knowledge of this disorder. This Seminar covers the basics, from terminology to aspects of diagnosis, treatment, and pathogenesis.     

Electroconvulsive Therapy and Parkinson's Disease

Five patients who suffered from Parkinson's disease received electroconvlsive therapy for concurrent depressive disorder. Temporary neurological improvement occurred in four patients. Observations on this improvement are presented, including its onset, duration, and relationship to mood improvement. Predictors of good response are discussed. Rigidity improves most. Improvement persists for one to two months. There was no adverse effect on memory functions. Change in parkinsonism rating scales preceded improvement in depression and did not relate to the extent of this improvement. In one case, improvement in partinsonism occurred without improvement in depression. It is concluded that ECT may improve symptoms of Parkinson's disease independently of its effects on depression. It may, therefore, be a useful symptomatic treatment of Parkinson's disease.     

熄风止颤合剂对PSI诱导的帕金森病模型大鼠脑的影响

目的 观察熄风止颤合剂对蛋白酶抑制因子Ⅰ(proteasome inhibitors I,PSI)诱导的帕金森病(PD)慢性动物模型大鼠行为学及大脑多巴胺神经元的影响.方法 雄性SD大鼠背部皮下注射PSI,制备慢性PD动物模型,将造模成功大鼠随机分为三组:分别以生理盐水、美多巴及熄风止颤合剂进行灌胃治疗,观察其行为学变化,并分别通过TUNEL法、电镜、免疫组织化学方法观察大鼠脑多巴胺神经元的变化.结果 中药熄风止颤合剂可以改善PD的症状,且中药组大鼠大脑中多巴胺神经元的密度高于美多巴组,细胞凋亡指数低于美多巴组.结论 熄风止颤合剂对PD有治疗作用,其作用可能是通过降低多巴胺神经元的凋亡.     

帕金森氏病药物治疗的探讨

帕金森病是一种常见的进行性神经变性疾病,主要以静止震颤、肌肉强直和运动减少为临床症状,其确切病因目前还不清楚,但可以肯定的是与很多因素有关,目前国内外对帕金森病的治疗均以药物为主。本文对帕金森病治疗的各种常用药物的主要研究进展及药物治疗原则做一介绍。     

Diagnostic steps for suspected Parkinson's disease

The diagnosis is made clinically, often independent of special tests, through a series of simple, carefully planned observations and maneuvers. The objective is to separate true Parkinson's disease from other conditions with parkinsonian features.