2021 年 38 巻 3 号 p. 320-324
Nearly 200 years after James Parkinson wrote ‘An essay on the shaking palsy’, advances in understanding of the pathogenesis of Parkinson's disease have led to the development of various therapies. In the early stages of Parkinson's disease, pharmacotherapy such as L–dopa, dopamine agonists, and MAO–B inhibitors play a central role in the treatment of motor symptoms. In the advanced stages, when movement complications such as wearing–off and dyskinesia appear, adjunct therapeutics such as COMT inhibitors, zonisamide, and adenosine A2A receptor antagonist are used. In addition to motor symptoms, Parkinson's disease is also associated with a wide variety of non–motor symptoms such as constipation, olfactory disturbance, REM sleep behavior disorder, and depression, which are observed from the prodromal phase, and orthostatic hypotension, cognitive dysfunction, and psychiatric symptoms, especially in the advanced stages. Recently, the importance of exercise and rehabilitation as non–pharmacological treatments has been reaffirmed, and they have become indispensable in the entire course of Parkinson's disease from the early stage to the advanced stage. In this article, I introduced the latest trends and prospects of Parkinson's disease treatment.
