《帕金森病研究进展》课件.pptVIP

　PD的药物和手术的协同治疗是 目前世界医学界已经取得的共识．　 脑立体定向手术 基底节核团毁损术仍是目前外科治疗PD的主要方法。该法定位准确是关键，选择不同靶点对临床症状改善程度不同。 深部脑刺激术(DBS) 用立体定向技术把电极植入丘脑底核或腹正中核或苍白球内侧部3个部位，以高频电流刺激靶点区，达到治疗目的。 现在的手术靶点：Gpi 、STN 现在的手术靶点： 苍白球腹内侧核（Gpi) 丘脑（Vim) 丘脑底核（STN） ActivaTM 运动控制系统 康复与心理治疗 ? 科普教育 ? 心理疏导 ? 支持 ? 营养 ? 锻炼 PD治疗中不容忽视的重要措施 * * １－甲基－４－苯基－１，２，３，６－四氢吡啶 * * * * * * * Strategies to improve levodopa delivery: Optimizing levodopa pharmacokinetics When administered alone, levodopa is rapidly decarboxylated to dopamine in the peripheral circulation and only 1% passes into the brain where it is required. By inhibiting the peripheral decarboxylation of levodopa, a DDCI such as carbidopa prolongs the plasma half-life of levodopa from 50 minutes to 1.5 hours, without increasing the time to reach maximum plasma levodopa concentration (tmax). However, even with this inhibition still only about 10% of a given levodopa dose enters the brain. By inhibiting the metabolism of levodopa to 3-methyldopa (3-OMD), co-administration of levodopa and a DDCI with the COMT inhibitor entacapone has been shown to: prolong levodopa’s elimination half-life in PD patients from 1.3 to 2.4 hours. increase levodopa plasma bioavailability (area under the time–concentration curve; AUC) between 25-50%. Gordin et al. Adv Neurol 2002; 91: 237–250. * One strategy in the management of symptom re-emergence due to wearing-off has been to increase the dose of conventional levodopa However, increasing the levodopa dose from 100 to 150 mg four-times daily increases the peaks and fails to eliminate troughs in the plasma levodopa levels, and thus still affecting efficacy H?nninen et al. Mov Disord 2007; 22(Suppl 16): S87 Stocchi. Expert Opin Pharmacother 2006; 7(10): 1399–407 * An important question for achieving continuous dopaminergic stimulation with oral levodopa is how many daily doses are required to achieve a more continuous stimulation, and more constant blood levels, with fewer troughs during the day Increasing the fre