Parkinson病および関連疾患の治療の進歩

抄録

We review reports published in 2016 providing new information on the management of Parkinson's disease (PD) and related disorders. In 2016, the Japanese Public Health Ministry authorized the use of levodopa/carbidopa intestinal gel for PD.

We report here the outcome of this new medical management of PD. Rivastigmine improved gait stability. Exercise trainings such as resistance training and cognitive motor intervention, were shown to be effective for muscle strength, parkinsonian motor symptoms and gait stability. A wearable technology such as inertial measurement units combined with a smartphone application (CuPiD–system) was useful for gait training. Modafinil improved excessive daytime sleepiness and exogenous melatonin improved quality of sleep and REM sleep behavior disorder. Rotigotine improved quality of sleep. Doxepin and Yang–Xue–Qing–Nao granules may be effective for sleep disturbance. Probiotics and prebiotic fiber relieved constipation in PD. Dipraglurant, a metabotropic glutamate receptor 5–negative allosteric modulator, but AQW051, a nicotinic acetylcholine receptor α7 agonist, reduced levodopa induced peak dose dyskinesia. Preladenant, an adenosine 2A antagonist, could not reduce off time in Japanese PD patients with wearing off. Phase 1 trial of PRX002, an anti–α–synuclein monoclonal antibody, resulted in safe and supported continued development of PRX002. Nilotinib, a tyrosine kinase Abelson inhibitor, was suggested to have beneficial effect on motor and cognitive function in PD and Dementia with Lewy bodies. For PD–related disorders of progressive supranuclear palsy, infusion of mesenchymal stroma cells into the cerebral arteries reduced progress of motor symptoms for at least 6 months. Rasagiline, a monoamine oxidase type B inhibitor, failed to reduce deterioration of motor and cognitive dysfunctions.