• 四川大學華西醫(yī)院神經內科,成都610041;

帕金森病是中老年人常見的中樞神經系統(tǒng)退行性疾病，在其早期給予合理的治療有利于提高患者的生活質量，降低長期用藥引起的運動并發(fā)癥。本文介紹有關早期帕金森病治療的臨床證據，干預措施包括多巴胺受體激動劑，左旋多巴制劑，及多巴胺能神經保護劑等藥物及早期步態(tài)訓練等。

引用本文： 彭 蓉,吳 妍,劉 鳴. 治療早期帕金森病的臨床證據. 中國循證醫(yī)學雜志, 2005, 05(9): 718-721. doi: 復制

1. BaroneP.Bravi D.Bermejo-ParejaF.Marconi R. Kulisevsky J. Malagu S. Weiser R. Rost N.Pergo1ide monotherapy in the treatment of early PD: a randomized,controlled study,Pergolide Monotherapy Study Group[J]. Neurology, 1999; 53(3):573-579.
2. Ramaker C.Van Hilten JJ. Bromocriptine versus levodopa in early Parkinson’s disease(Cochrane Review).In: The Cochrane Library, Issue 3,2000.Chichester, UK:John Wiley&Sons,Ltd.
3. Desboeuf K.Lapeyre-Mestre M.Senard JM.Rascol O.Brefel CC.Long-term mortality results of the randomized controlled study comparing bromocriptine to which levodopa was later added with levodova alone in previously untreated patients with Parkinson’s disease[J].Movement Disorders, 12001; 6(3):511-514.
4. Bracco F.Battaglia A.Dupont E.Gershanik O.Marti CC.Montastruc JL. PKDS009 Study Group.The long-acting dopamine receptor agonist cabergoline in early Parkinson’s disease: final results of a 5-year, double blind, levodopa controlled study[J]. CNS Drugs, 2004;18(11):733-746.
5. Ziegler N.Castro CA. Del SS.Rascol O.Efficacy of viribedil as early combination to levodopa in patients with stable Parkinson’s disease: a 6-month, randomized, placebo-controlled study[J]. Movement Disorders, 2003; 18(4):418-425.
6. Korczyn AD. Thalamas C. Adler CH. Dosing with ropinirole in a clinical setting[J]. Acta Neurologica Scandinavica, 2002;106(4):200-204.
7. Brooks DJ.Abbott RJ.Lees AJ.Martignoni E.Philcox DV.Rascol O.Roos RA.Sagar HJ.A placebo-controlled evaluation of ropinirole,a novel D2 agonist,as sole dopaminergic therapy in Parkinson’s disease[J].Clinical Neuropharmacology, 1998; 21(2):10l-107.
8. AdlerCH. Sethi KD.HauserRA. Davis TL. Hammerstad JP. Bertoni J. Taylor RL.Sanchez RJ.O’Brien CF. The Ropinirole Study Group. Ropinirole for the treatment of early Parkinson’s diseas[J]. Neurology, 1997; 49(2):393-399.
9. Sethi KD.O’Brien CF. Hammerstad JP.Adler CH. Davis TL.Taylor RL. Sanchez RJ. Bertoni JM. Hauser RA.Ropinirole for the treatment of early Parkinson disease: a 12-month experience[J]. Archives of Neurology, 1998; 55(9):1211-1216.
10. Rascol O. Brooks DJ. Korczyn AD. De Deyn PP. Clarke CE. Lang AE.A five-year study of the incidence of dyskinesia in patients with early Parkinson’s disease who were treated with ropinirole or levodopa[J]. NEJM, 2000; 342(20): 1 484-1 49l.
11. Whone AL, Watts RL, Stoessl AJ, Davis M, Reske S, Nahmias C, Lang AE, Rascol O, Ribeiro MJ,Remy P, Poewe WH,Hauser RA, Brooks DJ, REAL-PET Study Group.Slower progression of Parkinson disease with ropinirole versus levodopa: The REAL-PET study[J]. Annals of Neurology, 2003; 54(1): 93-101.
12. Parkinson Study Group. Pramipexole vs Levodopa as initial treatment for Parkinson disease:a 4-year randomized controlled trial[J]. Archives of Neutrology, 2004; 1044-1053.
13. Parkinsonn Study Group Dopamine transporter brain imaging to assess the effects of pramipexole vs levodopa on Parkinson disease progression[J].JAMA, 2002; 287(13): 1653-166l.
14. Korczyn AD, Brunt ER, Larsen JP, Nagy Z, Poewe WH, Ruggieri S. A 3-year randomized trial of ropinirole and bromocriptine in early ParkinSon’s disease[J]. Neutrology, 1999;53(2):364-370.
15. Schrag A, Keens J, Warner J, Ropinirole Study Group. Ropinirole for the treatment of tremor in early Parkinson’s disease[J]. European Journal of Neurology, 2002; 9(3):253-257.
16. Inzelberg R, Schechtman E, Nisipeanu P. Cabergoline, pramipexole and ropinirole used as monotherapy in early Parkinson’s disease: an evidence-based comparison[J]. Drugs Aging, 2003; 20(11):847-855.
17. Etminan M, Gill S, Samii A. Comparision of the risk of adverse events with pramipexole and ropinirole in patients with Parkinson’s disease: a meta-analysis[J]. Drug Safety, 2003; 26(6): 439-444.
18. Etminan M,Samii A, Takkouche B, Rochon PA. Increased risk of Somnolence with the new dopamine agonists in patients with Parkinson’s disease: a meta-analysis of randomised controlled trials[J]. Drug Safety, 2001; 24(11):863-868.
19. Lees AJ. Parkinson’s Disease Research Group of the United Kingdom. Comparison of therapeutic effects and mortality data of levododa and levodopa combined with selegiline in patients with early, mild Parkinson’s disease[J]. BMJ, 1995; 311(7 020): 1 602-1 607.
20. Olanow CW, Myllyla VV, Sotaniemi KA, LarSen JP, Palhagen S, Przuntek H, Heinonen EH, Kilkku O, Lammintausta R, Maki-Ikola O, Rinne UK.Effect of Selegiline on mortality in patients with Parkinson’s disease: a meta-analysis[J]. Neurology, 1998; 51(3):825-830.
21. Przuntek H, Conrad B, Dichgans J,Kraus PH, Krauseneck P, Pergande G, Rinne U,Schimrigk K, Schnitker J, Vogel HP. SELEDO:a 5-year long-term trial on the effect of Selegiline in early ParkinSonian patients treated with levodopa[J]. European Journal of Neurology, 1999;6(2):141-150.
22. The Parkinson Study Group. Effect of lazabemide on the progression of disability in early Parkinson’s disease[J]. Annals of Neurology, 1996; 40(1): 99-107.
23. Parkinson Study Group.A controlled, randomized, delayed-Start Study of rasagiline in early Parkinson disease[J]. Archives of Neurology, 2004; l(4):56l-566.
24. Ives NJ, Stowe RL, Marro J, Counsell C, Macleod A, Clarke CE, Gray R,Wheatley K.Monamine oxidase type B inhibitors in early Parkinson’s disease:meta-analysis of 17 randomised trials involving 3525 patients[J]. BMJ, 2004; 329(7 466):593.
25. Shults CW,OakesD, Kieburtz K, Beal MF, HaaS R, PlUmb S, Juncos JL, Nutt J,Shoulson I,Carter J, Kompoliti K, Molho E, Harrison M,Lew M.Parkinson Study Group. Effects of coenZy Ql0 in early Parkinson disease: evidence of slowing of the functional decline[J]. Archives of Neurology, 2002; 59(10):1 541-1 550.
26. Fahn S, Oakes D, Shoulson I,Kieburtz K, Rudolph A,Lang A, Olano W, Tanner C, Marek K, Parkinson Study Group.1evodopa and the progression of D01[J].NEJM, 2004; 351(24):2498-2508.
27. Koller WC, Hutton JT, Tolosa E, Capilldeo R. Immediate-release and Controlled-release Carbidopa/levodopa in PD:a 5-year randomized multi-center Study[J]. Neurology,1999; 53(5):1 012-1 019.
28. Block G, Liss C, Reines S, Irr J, Nibbelink D.Comparison of immediate-release and controlled release carbidopa/levodopa in Parkinson’s disease, a multi-center, 5-year study[J]. European Neurology,1997; 37(1):23-27.
29. Pohl M, Rockstroh G, Ruckriem S, Mrass G, Mehrholz J. Immediate effects of Speed-dependent treadmill training on gait parameters in early Parkinson’s disease[J]. Archives of Physical Medicine &Reh-abilitation, 2003; 84(12):1760-1766.
  1. 1. BaroneP.Bravi D.Bermejo-ParejaF.Marconi R. Kulisevsky J. Malagu S. Weiser R. Rost N.Pergo1ide monotherapy in the treatment of early PD: a randomized,controlled study,Pergolide Monotherapy Study Group[J]. Neurology, 1999; 53(3):573-579.
  2. 2. Ramaker C.Van Hilten JJ. Bromocriptine versus levodopa in early Parkinson’s disease(Cochrane Review).In: The Cochrane Library, Issue 3,2000.Chichester, UK:John Wiley&Sons,Ltd.
  3. 3. Desboeuf K.Lapeyre-Mestre M.Senard JM.Rascol O.Brefel CC.Long-term mortality results of the randomized controlled study comparing bromocriptine to which levodopa was later added with levodova alone in previously untreated patients with Parkinson’s disease[J].Movement Disorders, 12001; 6(3):511-514.
  4. 4. Bracco F.Battaglia A.Dupont E.Gershanik O.Marti CC.Montastruc JL. PKDS009 Study Group.The long-acting dopamine receptor agonist cabergoline in early Parkinson’s disease: final results of a 5-year, double blind, levodopa controlled study[J]. CNS Drugs, 2004;18(11):733-746.
  5. 5. Ziegler N.Castro CA. Del SS.Rascol O.Efficacy of viribedil as early combination to levodopa in patients with stable Parkinson’s disease: a 6-month, randomized, placebo-controlled study[J]. Movement Disorders, 2003; 18(4):418-425.
  6. 6. Korczyn AD. Thalamas C. Adler CH. Dosing with ropinirole in a clinical setting[J]. Acta Neurologica Scandinavica, 2002;106(4):200-204.
  7. 7. Brooks DJ.Abbott RJ.Lees AJ.Martignoni E.Philcox DV.Rascol O.Roos RA.Sagar HJ.A placebo-controlled evaluation of ropinirole,a novel D2 agonist,as sole dopaminergic therapy in Parkinson’s disease[J].Clinical Neuropharmacology, 1998; 21(2):10l-107.
  8. 8. AdlerCH. Sethi KD.HauserRA. Davis TL. Hammerstad JP. Bertoni J. Taylor RL.Sanchez RJ.O’Brien CF. The Ropinirole Study Group. Ropinirole for the treatment of early Parkinson’s diseas[J]. Neurology, 1997; 49(2):393-399.
  9. 9. Sethi KD.O’Brien CF. Hammerstad JP.Adler CH. Davis TL.Taylor RL. Sanchez RJ. Bertoni JM. Hauser RA.Ropinirole for the treatment of early Parkinson disease: a 12-month experience[J]. Archives of Neurology, 1998; 55(9):1211-1216.
  10. 10. Rascol O. Brooks DJ. Korczyn AD. De Deyn PP. Clarke CE. Lang AE.A five-year study of the incidence of dyskinesia in patients with early Parkinson’s disease who were treated with ropinirole or levodopa[J]. NEJM, 2000; 342(20): 1 484-1 49l.
  11. 11. Whone AL, Watts RL, Stoessl AJ, Davis M, Reske S, Nahmias C, Lang AE, Rascol O, Ribeiro MJ,Remy P, Poewe WH,Hauser RA, Brooks DJ, REAL-PET Study Group.Slower progression of Parkinson disease with ropinirole versus levodopa: The REAL-PET study[J]. Annals of Neurology, 2003; 54(1): 93-101.
  12. 12. Parkinson Study Group. Pramipexole vs Levodopa as initial treatment for Parkinson disease:a 4-year randomized controlled trial[J]. Archives of Neutrology, 2004; 1044-1053.
  13. 13. Parkinsonn Study Group Dopamine transporter brain imaging to assess the effects of pramipexole vs levodopa on Parkinson disease progression[J].JAMA, 2002; 287(13): 1653-166l.
  14. 14. Korczyn AD, Brunt ER, Larsen JP, Nagy Z, Poewe WH, Ruggieri S. A 3-year randomized trial of ropinirole and bromocriptine in early ParkinSon’s disease[J]. Neutrology, 1999;53(2):364-370.
  15. 15. Schrag A, Keens J, Warner J, Ropinirole Study Group. Ropinirole for the treatment of tremor in early Parkinson’s disease[J]. European Journal of Neurology, 2002; 9(3):253-257.
  16. 16. Inzelberg R, Schechtman E, Nisipeanu P. Cabergoline, pramipexole and ropinirole used as monotherapy in early Parkinson’s disease: an evidence-based comparison[J]. Drugs Aging, 2003; 20(11):847-855.
  17. 17. Etminan M, Gill S, Samii A. Comparision of the risk of adverse events with pramipexole and ropinirole in patients with Parkinson’s disease: a meta-analysis[J]. Drug Safety, 2003; 26(6): 439-444.
  18. 18. Etminan M,Samii A, Takkouche B, Rochon PA. Increased risk of Somnolence with the new dopamine agonists in patients with Parkinson’s disease: a meta-analysis of randomised controlled trials[J]. Drug Safety, 2001; 24(11):863-868.
  19. 19. Lees AJ. Parkinson’s Disease Research Group of the United Kingdom. Comparison of therapeutic effects and mortality data of levododa and levodopa combined with selegiline in patients with early, mild Parkinson’s disease[J]. BMJ, 1995; 311(7 020): 1 602-1 607.
  20. 20. Olanow CW, Myllyla VV, Sotaniemi KA, LarSen JP, Palhagen S, Przuntek H, Heinonen EH, Kilkku O, Lammintausta R, Maki-Ikola O, Rinne UK.Effect of Selegiline on mortality in patients with Parkinson’s disease: a meta-analysis[J]. Neurology, 1998; 51(3):825-830.
  21. 21. Przuntek H, Conrad B, Dichgans J,Kraus PH, Krauseneck P, Pergande G, Rinne U,Schimrigk K, Schnitker J, Vogel HP. SELEDO:a 5-year long-term trial on the effect of Selegiline in early ParkinSonian patients treated with levodopa[J]. European Journal of Neurology, 1999;6(2):141-150.
  22. 22. The Parkinson Study Group. Effect of lazabemide on the progression of disability in early Parkinson’s disease[J]. Annals of Neurology, 1996; 40(1): 99-107.
  23. 23. Parkinson Study Group.A controlled, randomized, delayed-Start Study of rasagiline in early Parkinson disease[J]. Archives of Neurology, 2004; l(4):56l-566.
  24. 24. Ives NJ, Stowe RL, Marro J, Counsell C, Macleod A, Clarke CE, Gray R,Wheatley K.Monamine oxidase type B inhibitors in early Parkinson’s disease:meta-analysis of 17 randomised trials involving 3525 patients[J]. BMJ, 2004; 329(7 466):593.
  25. 25. Shults CW,OakesD, Kieburtz K, Beal MF, HaaS R, PlUmb S, Juncos JL, Nutt J,Shoulson I,Carter J, Kompoliti K, Molho E, Harrison M,Lew M.Parkinson Study Group. Effects of coenZy Ql0 in early Parkinson disease: evidence of slowing of the functional decline[J]. Archives of Neurology, 2002; 59(10):1 541-1 550.
  26. 26. Fahn S, Oakes D, Shoulson I,Kieburtz K, Rudolph A,Lang A, Olano W, Tanner C, Marek K, Parkinson Study Group.1evodopa and the progression of D01[J].NEJM, 2004; 351(24):2498-2508.
  27. 27. Koller WC, Hutton JT, Tolosa E, Capilldeo R. Immediate-release and Controlled-release Carbidopa/levodopa in PD:a 5-year randomized multi-center Study[J]. Neurology,1999; 53(5):1 012-1 019.
  28. 28. Block G, Liss C, Reines S, Irr J, Nibbelink D.Comparison of immediate-release and controlled release carbidopa/levodopa in Parkinson’s disease, a multi-center, 5-year study[J]. European Neurology,1997; 37(1):23-27.
  29. 29. Pohl M, Rockstroh G, Ruckriem S, Mrass G, Mehrholz J. Immediate effects of Speed-dependent treadmill training on gait parameters in early Parkinson’s disease[J]. Archives of Physical Medicine &Reh-abilitation, 2003; 84(12):1760-1766.