Parkinson病及び関連疾患の治療の進歩

抄録

We review reports published in 2017 providing new information on the management of Parkinson's disease (PD). Exenatide, a glucagon–like peptide–1 (GLP–1) receptor agonist, had positive effects on practically defined off–medication Unified Parkinson's Disease Rating Scale (UPDRS) part 3 scores in PD, which were sustained beyond the period of exposure. Low–dose combination of rasagiline and pramipexole (P2B001) improved total–UPDRS scores and Parkinson Disease Quality of Life Scale–39. Omega–3 fatty acids and vitamin E co–supplementation led to a significant improvement in UPDRS after 12 weeks' intervention. No evidence supporting the efficacy of preladenant, the adenosine 2a receptor antagonist, as monotherapy was observed in this phase 3 trial. Dextromethorphan/quinidine and ADS–5102 (Amantadine) Extended–Release Capsules reduced levodopa–induced dyskinesia. Off time was reduced by treatment with once–daily dose of opicapone, a catechol O–methyltransferase (COMT) inhibitor, and safinamide, which is an aminoamide derivative that acts as a highly selective, reversible monoamine oxidase B (MAO–B) inhibitor and blocks voltage dependent sodium and calcium channels and reduces neuronal glutamate release. Focused ultrasound thalamotomy for patients with tremor–dominant PD showed improvements in medication–refractory tremor. Phase 1 trial of PRX002, anti–α–synuclein monoclonal antibody demonstrates serum α–synuclein can be safely decreased after single intravenous infusions. Human induced pluripotent stem cells (iPS cells)–derived dopaminergic progenitor cells survived as midbrain dopaminergic neurons in a primate model of PD (Macaca fascicularis) treated with MPTP for two years without causing any dangerous effects in the body. The animals implanted with iPS cells showed sustained improvement after two years. Virtual house calls from a neurologist are feasible for people with PD and do not significantly change quality of life compared to in–person visits. Unilateral deep brain stimulation of the pedunculopontine nucleus was not effective in improving balance, and falls in patients with progressive supranuclear palsy.