帕金森病和运动障碍疾病.ppt

Peak dose dyskinesias or dystonia are the most common form of motor fluctuation, and are often worse on the more parkinsonian side. The involuntary movements are often not as disabling as akinesia and rigidity, and most patients prefer to have dyskinesias rather than immobility. To treat these symptoms it is useful to reduce levodopa dosing concentrations at peak dose while trying to increase levodopa dosing concentrations at trough dose, according to the levodopa dosing curve. This may be done by switching from immediate-release levodopa to a controlled release form, or by reducing levodopa and adding a dopamine agonist, a COMT inhibitor or an MAO-B inhibitor. It is estimated that mean survival after onset of parkinsonism today is approximately 15 years. Survival is longer in those patients who at the first clinical assessment were non-demented. Survival has significantly improved since the widespread use of levodopa, provided the drug is started before the patient reaches UPDRS stage 2.5. The survival in Parkinson’s disease is longer than it is in multiple system atrophy or progressive supranuclear palsy. The most common causes of death are pulmonary infection/aspiration, pulmonary embolism, urinary tract infection, and complications of falls and fractures. This shows 215 parkinson patients who had onset and first clinic visit before January 1, 1974, when levodopa was least accessible to most of these patients. The observed survival is significantly reduced compared to expected survival in the general population of the same year of birth and same sex, with p 0.0001. Since the widespread use of levodopa, 565 parkinson patients had onset and were first seen after December 31, 1973 when levodopa was readily available in the study area, and covered by medical insurance. The survival is reduced compared to expected (p=0.029). The difference between the observed and expected survival in these patients is much smaller than in patients who had restricted access to levodo