运动波动-国际帕金森和运动障碍学会循证医学评论帕金森病治疗的最新进展。

IF 7.4 1区医学 Q1 CLINICAL NEUROLOGY

Movement Disorders Pub Date : 2025-03-08 DOI:10.1002/mds.30162

Rob M.A. de Bie MD, PhD, Regina Katzenschlager MD, Bart E.K.S. Swinnen MD, PhD, Marina Peball LLM, PhD, Shen-Yang Lim MD, Tiago A. Mestre MD, PhD, Santiago Perez Lloret MD, PhD, Miguel Coelho MD, Camila Aquino MD, MSc, PhD, Ai Huey Tan MD, Veronica Bruno MD, MPH, FRCPC, Joke M. Dijk MD, PhD, Beatrice Heim MD, PhD, Chin-Hsien Lin MD, PhD, Linda Azevedo Kauppila MD, MSc, Irene Litvan MD, René Spijker MSc, Klaus Seppi MD, João Costa MD, PhD, Cristina Sampaio MD, PhD, Susan H. Fox MD, PhD, Monty A. Silverdale MD, PhD

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引用次数: 0

摘要

目的：更新治疗帕金森病（PD）运动波动的循证医学建议。背景：国际帕金森和运动障碍学会（MDS）循证医学运动障碍委员会对帕金森病治疗的建议于2002年首次发表，并定期更新。目前的综述采用了一种新的方法，包括Cochrane偏倚风险工具和改良版的GRADE（分级推荐、评估、发展和评估）。方法：于2023年1月1日在MEDLINE、Embase和Cochrane数据库中进行文献检索，检索词为：帕金森病、左旋多巴，Embase数据库为随机对照试验（RCT）。研究的纳入标准为：PD患者，口服左旋多巴治疗，经历运动波动，调查至少在一个国家（商业）可获得的干预措施，研究设计RCT，随访时间至少3个月。结果：共纳入102项研究。评价左旋多巴缓释、普拉克索速释和缓释、罗匹尼罗速释、罗替戈汀、阿匹卡酮、沙非胺、双侧丘脑底核深部脑刺激（DBS）有效，并评价左旋多巴持续肠内输注、持续皮下左旋多巴、持续皮下阿波啡、罗匹尼罗缓释、罗匹尼罗贴片、恩他卡酮、雷沙吉兰、依曲defylline、金刚烷胺缓释、佐尼沙胺、经评估，双侧苍白球DBS和苍白球切开术对已经接受左旋多巴治疗的PD患者的运动波动可能有效。结论：有几种治疗方案可以改善PD患者的运动波动。这些建议将帮助医生和患者决定采用哪种干预措施。©2025作者。Wiley期刊有限责任公司代表国际帕金森和运动障碍学会出版的《运动障碍》。

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Update on Treatments for Parkinson's Disease Motor Fluctuations – An International Parkinson and Movement Disorder Society Evidence-Based Medicine Review

Objective

To update evidence-based medicine recommendations for treating motor fluctuations of Parkinson's disease (PD).

Background

The International Parkinson and Movement Disorder Society (MDS) Evidence Based Medicine in Movement Disorders Committee recommendations for the treatments of PD were first published in 2002 and regularly updated. The current review uses a new methodology, including the Cochrane Risk of Bias tool and a modified version of GRADE (Grading of Recommendations, Assessment, Development, and Evaluations).

Methods

On January 1, 2023, a literature search was conducted without date limit in the MEDLINE, Embase, and Cochrane databases using the following search terms: Parkinson disease, levodopa and, for the Embase database, randomized controlled trial (RCT). The inclusion criteria for studies were: patients with PD, on oral levodopa therapy, experiencing motor fluctuations, investigating an intervention that was (commercially) available in at least one country, study design RCT, and with a follow-up duration of at least 3 months.

Results

A total of 102 studies were included. Levodopa extended release, pramipexole immediate release and extended release, ropinirole immediate release, rotigotine, opicapone, safinamide, and bilateral subthalamic nucleus deep brain stimulation (DBS) were assessed as efficacious, and continuous intestinal levodopa infusion, continuous subcutaneous levodopa, continuous subcutaneous apomorphine, ropinirole prolonged release, ropinirole patch, entacapone, rasagiline, istradefylline, amantadine extended release, zonisamide, bilateral globus pallidus DBS, and pallidotomy were assessed as likely efficacious for the treatment of motor fluctuations in people with PD who are already being treated with levodopa.

Conclusions

There are several treatment options that can improve motor fluctuations in PD. These recommendations will assist physicians and patients in determining which intervention to use. © 2025 The Author(s). Movement Disorders published by Wiley Periodicals LLC on behalf of International Parkinson and Movement Disorder Society.

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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.