神精病学：帕金森病.ppt

药物治疗疗效减退时可考虑手术治疗 最常采用： 脑深部电刺激(deep brain stimulation,DBS) 神经科 吴琪 探索新治疗 细胞移植治疗 基因治疗 神经科 吴琪 帕金森病的康复治疗 运动疗法：太极、瑜伽、体操、球类等 步态训练 构音和吞咽训练 神经科 吴琪 中医、心理治疗 预后 慢性进展，无根治方法 死亡原因：并发症 神经科 吴琪 小结 发病机制：多巴胺↓，多因素相关 临床表现 运动症状 非运动症状 强直 运动迟缓 姿势步态异常 帕金森病 静止性震颤 治 疗 药物、手术 康复、心理 护理 神经科 吴琪 何谓慌张步态、静止性震颤、齿轮样强直？ 帕金森病生化变化及多巴胺的代谢过程？ 左旋多巴所致运动并发症有哪些？ 复 习 题 神经科 吴琪 关注帕金森病，关爱帕金森病人 ４.１１ 世界帕金森病日 * * Section I Pharmacological agents available for the symptomatic relief of the motor features of PD include levodopa, dopamine agonists, selective monoamine oxidase B (MAO-B) inhibitors, as well as anticholinergics and amantadine. Patient characteristics are the most important factors in the selection of initial drug therapy. The drug’s benefits should be weighed against potential short- and long-term side effects and complications. Anticholinergics can be used in young patients in whom tremor is the major symptom; however, the frequent side effects of these agents limit their usage, particularly in older patients. Amantadine has weak antiparkinsonian actions; nevertheless, it is sometimes considered for initial therapy.1 Consequently, although direct head-to-head comparisons of efficacy among these agents are lacking, clinical experience suggests that dopaminergic agents are more potent than the anticholinergics, amantadine and selective MAO-B inhibitors.2 American Academy of Neurology guidelines3 and the evidence-based review of the Movement Disorder Society4 suggest that initial therapy with levodopa or a dopamine agonist is a reasonable option. Dopamine agonists have the advantage of delaying the introduction of levodopa, allowing for a lower dose of levodopa when necessary (and thus preventing motor complications) and, in the case of pramipexole and ropinirole in particular, having a potential disease-modifying effect.5 In patients treated with levodopa, the routine adjuvant use of a dopa-decarboxylase inhibitor such as carbidopa o