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巴金森氏症的治療與最新藥物進展

Parkinson's Disease Treatment and New Drugs Development

摘要


巴金森氏症是一常見的神經退化疾病。其臨床症狀包括有動作緩慢,僵硬,休息式顫抖等運動相關的症狀,也有許多非動作症狀。巴金森氏症目前無法被治癒,但臨床上仍有許多藥物可以提供症狀治療。在巴金森早期,治療主要著重於改善生活品質,藉由藥物調整以模擬生理現象的『腦中持續性巴胺刺激』來預防或延後動作併發症的出現。而在巴金森後期,當運動併發症出現後,治療則著重於如何調整藥物以增加病患『有電』,減少『沒電』的時候,並且降低異動症的發生以及嚴重度。此文章前段將簡述巴金森氏症的藥物與治療概念,後段則介紹目前臺灣市面上治療巴金森氏症的三種新藥,以及其他台灣沒有的藥物。

並列摘要


Parkinson's disease (PD) is a common neurodegenerative disease. Clinical symptoms of PD include motor symptoms of bradykinesia, rigidity, rest tremor, and various non-motor symptoms. To date, there is no cure for PD, but we have many medications for symptomatic relieve and improvement of patients' quality of life. The medications for PD include levodopa, dopamine agonist, monoamine oxidase B inhibitor, and cate-O-methyltransferase inhibitor. In early-stage PD, treatment focuses on improving quality of life and prevention or delaying the development of motor complication by adjusting medications to mimic the physiological continuous dopaminergic stimulation in brain. In advanced stage of PD, treatment focuses on how to decrease daily "off" time, increase "on" time and improve dyskinesia. The first part of this article will describe the medications for PD and treatment concept. The second part of this article will describe the three new drugs for PD in Taiwan and other new PD medications outside Taiwan.

參考文獻


Abbott A. Levodopa: the story so far. Nature 2010;466:S6-7. https://doi.org/10.1038/466S6a
Olanow CW, Calabresi P, Obeso JA. Continuous dopaminergic stimulation as a treatment for Parkinson's disease: Current status and future opportunities. Mov Disord 2020;35:1731-44. https://doi.org/10.1002/mds.28215
Cilia R, Akpalu A, Sarfo FS, et al. The modern pre-levodopa era of Parkinson's disease: insights into motor complications from sub-Saharan Africa. Brain 2014;137(Pt 10):2731-42. https://doi.org/10.1093/brain/awu195
Olanow CW, Rascol O, Hauser R, et al. A double-blind, delayed-start trial of rasagiline in Parkinson's disease. N Engl J Med 2009;361:1268-78. https://doi.org/10.1056/NEJMoa0809335
Rascol O, Hauser RA, Stocchi F, et al. Long-term effects of rasagiline and the natural history of treated Parkinson's disease. Mov Disord 2016;31:1489-96. https://doi.org/10.1002/mds.26724

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