各種デバイス療法の導入時期と適した患者像

抄録

Parkinson disease (PD) is a neurodegenerative disorder primarily driven by the pathological aggregation and propagation of α‐synuclein, which leads to dopaminergic neuron degeneration and the emergence of parkinsonism. Since the introduction of levodopa (LD) in 1970, PD management has been largely in the realm of neurology. However, despite advances in medical therapy, many patients experience unsatisfactory outcomes under conventional internal medicine approaches. This review examines alternative treatment options that extend beyond standard best medical treatment (BMT), emphasizing the importance of device‐aided therapies (DAT) and stereotactic neurosurgical procedures.

PD predominantly affects the elderly, and earlier disease onset is associated with a more detrimental impact on survival. The advent of LD provided a “honeymoon period” during which motor function remains relatively stable, but over time, motor complications (MC) such as dyskinesia from excessive stimulation and wearing‐off phenomena from insufficient efficacy emerge, significantly impairing quality of life. These motor complications are attributed not only to reduced dopaminergic production but also to diminished dopamine reuptake and compensatory serotonergic activity.

To address these issues, two main strategies are employed : continuous dopaminergic stimulation (CDS) via continuous drug delivery (CDD) systems and direct modification of the cortico–basal ganglia circuitry through stereotactic surgeries, including deep brain stimulation (DBS). The review highlights that neurologists must recognize the limitations of internal medical therapies, overcome therapeutic inertia, and timely refer patients to specialized centers for DAT and stereotactic interventions, thereby optimizing both motor outcomes and long‐term survival in PD.