特集 Lewy小体病の診断と治療の新たな展開
Parkinson病の運動症状の治療
キーワード:
Parkinson disease,
dopamine replacement therapy,
continuous dopaminergic therapy,
device–aided therapy,
late stage
2020 年 37 巻 1 号 p. 16-19
詳細
2020 年 37 巻 1 号 p. 16-19
Parkinson's disease is a neurodegenerative disease cardinally showing movement disorders. Motor symptoms are manifested by magnification of Lewy pathology into the substantia nigra pars compacta, which induces dopaminergic neuronal loss and dopamine deficiency in the nigro–striatal dopaminergic projection. Therefore, dopamine replacement therapy is the gold standard in pharmacotherapy in Parkinson's disease. Now a days, dopaminergic agonists, dopamine economizers as well as non–dopaminergic agents are clinically available in Japan. Drug delivery systems have also been improving. Transdermal and intrajejunal formulations are available in Japan, whereas subcutaneous continuous injection, inhaler and sublingual film are available and developing in foreign countries. Most of them are based on the therapeutical concept of continuous dopaminergic stimulation. Neuromodulation and exercise are also important therapeutic interventions in motor treatment in Parkinson's disease. Deep brain stimulation and L–dopa carbidopa intestinal gel are categorized as device–aided therapy, which are applicable to advanced stage. Next to the advanced stage, late stage will inevitably come and variable refractory problems in this stage can deteriorate qualities of life. The qualities of life in the late stage can come at the expense of pharmacotherapy of motor symptoms, which should be established on the well–organized communication and an advanced adherence among patients, physicians, and care givers.
