International Parkinson and movement disorder society evidence-based medicine review: Update on treatments for the motor symptoms of Parkinson's disease

IF 7.4 1区医学 Q1 CLINICAL NEUROLOGY

Movement Disorders Pub Date : 2018-03-23 DOI:10.1002/mds.27372

Susan H. Fox MRCP, PhD, Regina Katzenschlager MD, Shen-Yang Lim MD, FRACP, Brandon Barton MD, MS, Rob M. A. de Bie MD, PhD, Klaus Seppi MD, Miguel Coelho MD, Cristina Sampaio MD, PhD, on behalf of the Movement Disorder Society Evidence-Based Medicine Committee

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引用次数: 567

Abstract

Objective: The objective of this review was to update evidence-based medicine recommendations for treating motor symptoms of Parkinson's disease (PD).

Background: The Movement Disorder Society Evidence-Based Medicine Committee recommendations for treatments of PD were first published in 2002 and updated in 2011, and we continued the review to December 31, 2016.

Methods: Level I studies of interventions for motor symptoms were reviewed. Criteria for inclusion and quality scoring were as previously reported. Five clinical indications were considered, and conclusions regarding the implications for clinical practice are reported.

Results: A total of 143 new studies qualified. There are no clinically useful interventions to prevent/delay disease progression. For monotherapy of early PD, nonergot dopamine agonists, oral levodopa preparations, selegiline, and rasagiline are clinically useful. For adjunct therapy in early/stable PD, nonergot dopamine agonists, rasagiline, and zonisamide are clinically useful. For adjunct therapy in optimized PD for general or specific motor symptoms including gait, rivastigmine is possibly useful and physiotherapy is clinically useful; exercise-based movement strategy training and formalized patterned exercises are possibly useful. There are no new studies and no changes in the conclusions for the prevention/delay of motor complications. For treating motor fluctuations, most nonergot dopamine agonists, pergolide, levodopa ER, levodopa intestinal infusion, entacapone, opicapone, rasagiline, zonisamide, safinamide, and bilateral STN and GPi DBS are clinically useful. For dyskinesia, amantadine, clozapine, and bilateral STN DBS and GPi DBS are clinically useful.

Conclusions: The options for treating PD symptoms continues to expand. These recommendations allow the treating physician to determine which intervention to recommend to an individual patient. © 2018 International Parkinson and Movement Disorder Society

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国际帕金森和运动障碍学会循证医学评论:帕金森病运动症状治疗的最新进展

目的:本综述的目的是更新治疗帕金森病(PD)运动症状的循证医学建议。背景:运动障碍学会循证医学委员会关于PD治疗的建议于2002年首次发表，并于2011年更新，我们继续审查至2016年12月31日。方法:回顾运动症状干预措施的一级研究。纳入标准和质量评分如前所述。考虑了五种临床适应症，并报告了有关临床实践意义的结论。结果:共有143项新研究符合要求。没有临床上有用的干预措施来预防/延缓疾病进展。对于早期PD的单药治疗，非麦角多巴胺激动剂、口服左旋多巴制剂、selegiline和rasagiline在临床上是有用的。对于早期/稳定PD的辅助治疗，非麦角多巴胺激动剂、雷沙吉兰和唑尼沙胺在临床上是有用的。对于优化PD的一般或特定运动症状(包括步态)的辅助治疗，利瓦斯汀可能是有用的，物理治疗在临床上是有用的;基于练习的运动策略训练和形式化的模式练习可能是有用的。关于预防/延缓运动并发症的研究没有新的进展，结论也没有变化。对于治疗运动波动，大多数非麦角多巴胺激动剂、培高利特、左旋多巴内啡肽、左旋多巴肠内输注、恩他卡彭、阿匹卡彭、雷沙吉兰、唑尼沙胺、沙非胺以及双侧STN和GPi DBS在临床上都是有用的。对于运动障碍，金刚烷胺、氯氮平、双侧STN DBS和GPi DBS在临床上是有用的。结论:治疗PD症状的选择继续扩大。这些建议使主治医生能够决定向个别患者推荐哪种干预措施。©2018国际帕金森和运动障碍学会

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来源期刊

Movement Disorders 医学-临床神经学

CiteScore

13.30

自引率

8.10%

发文量

371

审稿时长

12 months

期刊介绍： Movement Disorders publishes a variety of content types including Reviews, Viewpoints, Full Length Articles, Historical Reports, Brief Reports, and Letters. The journal considers original manuscripts on topics related to the diagnosis, therapeutics, pharmacology, biochemistry, physiology, etiology, genetics, and epidemiology of movement disorders. Appropriate topics include Parkinsonism, Chorea, Tremors, Dystonia, Myoclonus, Tics, Tardive Dyskinesia, Spasticity, and Ataxia.